Date of Award
6-6-2024
Scholarly Projects
Projects: SPU Access Only
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Faculty Chair
Erla Champ-Gibson
Faculty Reader
Erla Champ-Gibson
Faculty Reader
Deborah Saknit
Executive Summary
Executive Summary
Background and Significance: Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive approach for treating thoracic aortic diseases, often necessitating collaboration between cardiac and vascular surgeons (Capoccia et al., 2021; Hodgson, 2006). Despite its benefits in reducing hospital stays and improving outcomes, the success of TEVAR is contingent upon effective postoperative management, which involves consistent follow-up care and surveillance. A retrospective analysis conducted across multiple hospitals revealed that the post-TEVAR compliance rate is approximately 73%, with nearly one-third of patients not receiving the recommended follow-up care in accordance with surveillance guidelines (Meena et al., 2018). The Society for Vascular Surgery (SVS) recommends contrast-enhanced computed tomography (CT) scans at one month and twelve months post-TEVAR, followed by annual scans for life to monitor for potential complications (Upchurch et al., 2021). However, the current practices lack a standardized, multidisciplinary approach, leading to gaps in patient care and an increased risk of complications.
Problem Statement: The lack of a standardized follow-up protocol for patients after TEVAR leads to inconsistent care and potential delays in managing postoperative complications. This gap becomes particularly evident during the transition of care between cardiac and vascular surgeons, highlighting the need for a cohesive, interprofessional follow-up strategy.
Purpose: The project aims to develop and implement a standardized nursing post-TEVAR follow-up protocol and documentation template to foster multidisciplinary collaboration and enhance continuity of care. The intervention is intended to improve staff nurses' knowledge and bridge the gaps in communication and care between cardiac and vascular surgery teams.
Methods: This quality improvement project aims to evaluate the impact of structured follow-up care tools on enhancing nurses' abilities to care for post-TEVAR patients and on improving multidisciplinary collaboration between cardiac and vascular surgery teams. All staff nurses from the cardiac and vascular surgery clinics have been invited via separate emails containing a pre-intervention survey, educational materials, and a post-intervention survey. The project lead and staff nurses have reviewed three educational items in person together. These materials, which include a one-page succinct TEVAR information sheet, a post-TEVAR care flowchart, and a standardized post-TEVAR follow-up charting template, were also displayed in the staff break room and emailed to all participants. Participation in the project is entirely voluntary. Pre- and post-intervention surveys are administered to assess the participants' understanding and knowledge with Likert scale questionnaires.
Results: Nine participants completed the pre-intervention survey, and five participants completed the post-intervention survey. The project lead collected and analyzed ordinal data from the Likert scale responses. After learning the educational materials for six weeks, the majority of participants demonstrated increased knowledge of the post-TEVAR follow-up, which includes aspects such as activity precautions, ideal blood pressure parameters, incisional care, and the CTA CAP imaging surveillance timeline. The participants have the most significant improvement in understanding and knowledge about the entire process of post-TEVAR follow-up protocol, with the mean score increasing from 2.89 to 4.6 out of 5, the mean score difference is 1.71 score. The smallest improvement is the understanding and knowledge about CTA CAP imaging surveillance after TEVAR with mean score difference of 0.96. The post-intervention feedback on the educational materials indicated that over 80% of participants rated a good to excellent understanding level of the post-TEVAR charting template and the flowchart decision tree for post-TEVAR outpatient care.
Sustainability: Based on the results, the project has positively impacted staff nurses by enhancing the care provided to post-TEVAR patients and clarifying the direction of care provision. The standardized charting template has been instrumental in aligning the vascular and cardiac surgery teams on a common communicative platform. The use of a standardized tool across the organization enables everyone to work with a unified understanding of tasks, potentially reducing errors, increasing efficiency, and fostering a culture of collaboration and trust (Etherington et al., 2021; Rawlingson et al., 2021; Saint-Pierre et al., 2018; Schot et al., 2019). With the educational resources and charting template, multidisciplinary collaboration is within reach and can help bridge communication gaps. The flowchart guides staff nurses in patient care navigation. To sustain the project, the educational materials and charting template should be periodically updated by the lead staff nurses from either the cardiac or vascular surgery team.
Implications: Stakeholders—including nurse managers, nurse practitioners, care coordinators, staff nurses, cardiac surgeons, and vascular surgeons—have concurred on the adoption of the charting template to optimize patient care. The charting template has been in use since August 2023. Establishing a standardized post-TEVAR follow-up protocol is crucial for improving both the continuity and quality of patient care. This initiative could ensure better coordination between cardiac and vascular surgery teams, enhance nursing staff's understanding and management of post-TEVAR care, and ultimately contribute to improve patient outcomes.
References:
Capoccia, M., Pal, S., Murphy, M., Mireskandari, M., Hoschtitzky, A., Nienaber, C. A., Cheshire, N. J., & Rosendahl, U. P. (2021). Cardiac and Vascular Surgeons for the Treatment of Aortic Disease: A Successful Partnership for Decision-Making and Management of Complex Cases. Journal of Investigative Medicine High Impact Case Reports, 9, 2324709620970890. https://doi.org/10.1177/2324709620970890
Etherington, C., Burns, J. K., Kitto, S., Brehaut, J. C., Britton, M., Singh, S., & Boet, S. (2021). Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework. PLoS ONE, 16(4), e0249576. https://doi.org/10.1371/journal.pone.0249576
Hodgson, K. J. (2006). Clinical competence statement on thoracic endovascular aortic repair (TEVAR)—Multispecialty consensus recommendations. Journal of Vascular Surgery, 43(4), 858–862. https://doi.org/10.1016/j.jvs.2006.01.002
Meena, R. A., Benarroch-Gampel, J., Leshnower, B. G., Escobar, G. A., Duwayri, Y., Jordan, W. D., & Rajani, R. R. (2019). Surveillance Recommendations after Thoracic Endovascular Aortic Repair Should Be Based on Initial Indication for Repair. Annals of Vascular Surgery, 57, 51–59. https://doi.org/10.1016/j.avsg.2018.11.001
Rawlinson, C., Carron, T., Cohidon, C., Arditi, C., Hong, Q. N., Pluye, P., Peytremann-Bridevaux, I., & Gilles, I. (2021). An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators. International Journal of Integrated Care, 21(2), Article 2. https://doi.org/10.5334/ijic.5589
Saint-Pierre, C., Herskovic, V., & Sepúlveda, M. (2018). Multidisciplinary collaboration in primary care: A systematic review. Family Practice, 35(2), 132–141. https://doi.org/10.1093/fampra/cmx085
Schot, E., Tummers, L., & Noordegraaf, M. (2020). Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34(3), 332–342. https://doi.org/10.1080/13561820.2019.1636007
Upchurch, G. R., Escobar, G. A., Azizzadeh, A., Beck, A. W., Conrad, M. F., Matsumura, J. S., Murad, M. H., Perry, R. J., Singh, M. J., Veeraswamy, R. K., & Wang, G. J. (2021). Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. Journal of Vascular Surgery, 73(1), 55S-83S. https://doi.org/10.1016/j.jvs.2020.05.076
Recommended Citation
Chin, Shan Sze, "A Multidisciplinary Approach to Implement an Outpatient Follow-up Protocol for Post-TEVAR Patients: A Quality Improvement Project" (2024). Doctor of Nursing Practice (DNP) Scholarly Projects. 83.
https://digitalcommons.spu.edu/shs_dnp/83