Learning Objective #1: Describe how changing the practice to a specialized vascular unit helped to decrease costs for vascular surgery patient

Learning Objective #2: Describe how changing the pracitce to a specialized vascular unit helped to decrease LOS and eliminate need for ICU

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Increasing healthcare costs, scarcity of critical care beds and managed care capitation posed a challenge for maintaining cost effective quality care for patients having elective major vascular procedures. These issues served as the impetus to look at practice changes that would allow for the care of the stable vascular patient on one unit from admission through discharge A multidisciplinary team investigates how to safely change practice. An extensive literature search was completed to identify national trends. Practice changes were initiated in 1997 after educating the nursing staff, and purchasing equipment needed for monitoring the surgical vascular patient. Initially the stable carotid endarterectomy and lower extremity bypass vascular surgical patients were sent directly to this unit, bypassing the ICU and allowing for care from immediate post op to discharge. This change increased satisfaction for patients and families and facilitated earlier discharge. The program was expanded to other vascular cases, including non- coronary stent procedures, AAA stent procedures and open AAA repair. Outcome pathways were developed to eliminate the variances. Practice changes have progressed so that all vascular surgeries, with the exception of those requiring mechanical ventilation, are admitted to this vascular specialty area. Thoracotomies and chest surgeries other than CABG were also added to again provide for shorter LOS and eliminating the need for an ICU stay. The goals have been met with continued success in decreased LOS of all vascular cases and decreased costs, while readmission rates and mortality rates of this program remain below the national average. Establishing a specialized vascular/thoracic unit has been successful in decreasing LOS, improving utilization of resources and maintaining quality outcomes for the vascular and thoracic patient.