Preparing, optimising and reducing trauma in cardiac operations (PORTICO) Papworth Hospital NHS Foundation Trust

The Papworth Hospital NHS Foundation Trust team introduced an enhanced recovery care pathway to optimise the condition of older patients before cardiac surgery and to reduce physical and psychological stress. The overall aim was to enable patients to return to normal functioning as soon as possible. 

The PORTICO (Preparing, optimising and reducing trauma in cardiac operations) pathway focused on patients aged 80 and over, or under 80 with comorbidities, disabilities or frailties. It included: 

• optimising patient condition between outpatient clinic and surgery (8–12 weeks)
• educating patients and families about active recovery
• providing an expected date of discharge
• giving patients PORTICO information and a patient diary to record their experience of care
• monitoring post-operative progress
• giving patients a discharge summary and details of who to contact with any concerns.

Who was involved

The project team included the trust's director of operations, two clinical directors and a consultant anaesthetist. Project management support came from the service improvement team.

Outcomes

• 142 patients completed the pathway.
• Mean length of stay reduced from 13.2 days to 9.9 days.
• 30% achieved the target length of stay of six days.
• Increased length of stay was found to be associated with three main post-operative complications: atrial fibrillation, confusion/delirium and blood loss.
• 100% of patients said that the results of their operation were 'good' or 'excellent'.

Challenges

The project team found that aiming for a mean length of stay of six days for all patients was overly optimistic.

Recruitment for the project was slow at first, but having nurses identify potential candidates in the outpatient clinic helped to increase enrolment.