Nursing intervention after carotid endarterectomy: a randomized trial of Co-ordinated Care Post-Discharge (CCPD)

Authors

  • Sandy Middleton BAppSc MN PhD RN,

  • Neil Donnelly BSc MPH,

  • John Harris MBBS MS FRACS FRCS FACS DDU,

  • Jeanette Ward MBBS MHPEd PhD FAFPHM


Sandy Middleton,
Australian Catholic University,
PO Box 968,
North Sydney,
New South Wales 2059,
Australia.
E-mail: s.middleton@mackillop.acu.edu.au

Abstract

Aim.  This paper reports a study evaluating the short-term impact of nursing-led, co-ordinated care after discharge following carotid endarterectomy.

Background.  Patient education about stroke risk factors, combined systematically with carotid endarterectomy, holds unrealized potential to improve patient outcomes. Nurses are well-placed in the healthcare system to co-ordinate this type of education.

Methods.  A randomized controlled trial was conducted between October 2001 and October 2002. Patients having carotid endarterectomy (n = 133) were randomized to either the intervention (n = 66) or control group (n = 67). The intervention consisted of telephone liaison with the patient by a Registered Nurse at 2, 6 and 12 weeks following carotid endarterectomy, combined with education about stroke risk factor management and structured liaison with the patient's surgeon and referring general practitioner. While patients allocated to the control group did not receive any postoperative telephone contact directly from the Registered Nurse during the study, their general practitioners received structured postoperative liaison.

Results.  The co-ordinated care postdischarge intervention had a statistically significant positive effect on patient knowledge of stroke warning signs (P = 0·002), patient self-reported changes to improve lifestyle (P = 0·006) and diet modification (P < 0·001). Statistically significant improvements from baseline to follow-up were detected in both groups for other outcomes.

Conclusions.  While nursing-led, co-ordinated care after discharge achieves important improvements for short-term outcomes, carotid endarterectomy itself may have been a catalyst for improved patient outcomes. Further research of nursing-led co-ordinated care initiatives for vascular surgery patients is needed.

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