PubMed · 6909638
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C Lucero. Nurses in action.. https://pubmed.ncbi.nlm.nih.gov/6909638/
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OBJECTIVE: In restructuring the Quebec health care system with hospital budget cuts, salary ceiling of physicians and a small number of practising cardiac surgeons, the future of this specialty needs to be defined beyond individual self-interest. To evaluate the actual situation and to suggest changes that will improve surgical care delivery in cardiac surgery, surgeon and centre case loads in the province of Quebec were reviewed. DESIGN: Retrospective study. SETTING: Province of Quebec, 1994. PATIENTS: Patients who underwent coronary artery bypass grafting in 1994. RESULTS: The rate of coronary bypass grafting in Quebec was similar to that in Canada as a whole. The number of patients undergoing coronary artery bypass grafting increased at a rate of 6.5%/year during the five years preceding 1994, when operations numbered 5000. Thus, 7000 procedures will be performed in the year 2000 if the actual increase remains similar. There are 12 centres performing cardiac surgery in Quebec, with one centre/600,000 population and 3.4 surgeons/centre, compared with one centre/800,000 population and 3.7 surgeons/centre in Canada. In the year 2000, to accommodate 7000 cases, 18 centres will be required for a minimal case load per centre (300 cases/centre) or nine centres for an optimal case load per centre (700 cases). CONCLUSION: Each centre of cardiac surgery should perform an optimal volume of cases to achieve maximal use of human and physical resources devoted to the care of cardiac surgical patients in the province of Quebec.
Nurses working in cardiovascular surgery must be responsible and highly competent to meet the demands of their profession. Hospitals that hire nurses for cardiovascular surgery also must assume responsibility for the competency of nurses hired. The Virginia Heart Center at Fairfax Hospital, Falls Church, uses a competency-based orientation plan to train newly hired cardiovascular surgery nurses in providing quality care. Competency-based orientation is an effective approach to incorporating new members of the team into the work environment. The benefits of this appraoch include the development of teamwork and esprit de corps, skill and knowledge enhancement, and possible increased staff retention.
Until now, all reflections about cardiac surgery have been quantitative. Currently, quantitative saturation of cardiac surgery needs in France has been reached or even exceeded in some areas. Consequently, a qualitative approach becomes fundamental: to provide each patient, prior to the operation, with an assessment of his/her vital risk at a specific site; to allow cardiologists to objectively and statistically know the complete results obtained by various surgical teams; to incite improvements among surgical teams; and lastly, to allow the administration to assess services provided to patients. This study concerns 1271 patients consecutively operated on between January 1990 and December 1993 by the very same surgeon and represents the outline of a logical method of controlling clinical results.