Regular theatre spot for irregular heartbeat patients

One of the last things a patient with a heart problem wants to experience is any anxiety over their hospital appointments.

Until now those who are waiting for Cardioversion treatment for their irregular heart rhythm have always been aware that their appointment could be postponed if an emergency patient needed their bed on the coronary care ward.

The senior nursing staff on the Ashford and St. Peter’s Hospitals coronary care ward have solved the problem by enlisting the support of their day surgery unit colleagues. As a result they are now able to treat the patients in the day surgery unit rather than on the coronary care ward itself, considerably reducing the chance of such an appointment needing to be postponed.

This may sound simple and easy to achieve, but making such changes has required a great deal of research and a collaborative approach to bring the project to the point where the coronary care ward manager Tracey Bradshaw could write the Protocol to be followed for such patients.  Cardioversion now has its own dedicated place and anaesthetist on the day surgery list at St. Peter’s Hospital.

Tracey and deputy sister Tessa Martin visited Eastbourne Hospital where Cardioversions are carried out in the day surgery unit and their research included looking at other hospital’s protocols.

Senior coronary care nursing staff have been carrying out the Cardioversion treatment, together with a Senior House Officer, for about 10 years.  In the last six months Tracey, Tessa and deputy sisters Eithne Masterton, Emma Edwards, and Mary Burkett have been carrying out the procedure on patients without the need for an Senior House Officer. (SHO) 

Said Tracey: “A Cardioversion provides good, non-invasive instant care and there’s a high success rate.  Until now we couldn’t guarantee a bed on the appointed day and patients had to be cancelled because of emergency coronary care admissions, mainly from A&E. Patients had to be forewarned that this could happen.

“Now they have no anxiety about possible cancellation.  Patients are pre-assessed the day before and on the day of the procedure they are in and out in half-a day. After 24 hours they can drive and they can be back at work the next day.

“Our day surgery colleagues have been very keen and supportive and it’s true to say this work has been an example of good collaboration between us all.”

Day Surgery Sister Rowena Barrett said that this was another good example of things moving into the day surgery remit that was made possible because of the flexibility and willingness of all concerned to take on something new.

Said Rowena: “We are surgical staff and the coronary care staff are medical, and it’s interesting to see how two completely different specialties have been able to work hand-to-hand to provide this improved service for patients.    We think this is a good example of collaboration and is an achievement for both specialities.”

Patients who need Cardioversion treatment have been experiencing an irregular hear rhythm in the form of either AtrialFibrillation or Artrial Flutter. They may not be aware of this until they are brought into hospital as an emergency. Others experience palpitations or may feel breathless or light-headed. Their irregular heartbeat causes the two top chambers of the heart to fail to pump the blood out properly.  This leads to a rise in static blood at the base of those two top chambers which in turn brings the risk of blood clots forming which could cause a stroke. To reduce this risk patients are put on blood-thinning drugs such as Warfarin, which they may be able to come off after the Cardioversion.

Said Tracey: “The Cardioversion procedure itself only takes a few minutes to perform and is carried out under a light anaesthetic in the day surgery theatre.  We use two paddles to deliver a small electric shock to the heart which stops the irregular rhythm and allows a normal rhythm to take over. The patients are usually back on the day surgery ward half-an-hour after they left, looking forward to their cup of tea!”