Open heart surgery is a highly complex procedure, which benefits many, many patients. Achieving excellent results requires a team approach and a large range of special skills. Attention to detail and a seamless process form the foundation of our system of care at Beth Israel Cardiac Surgery. In most centers, patient care is primarily directed by doctors in training or delegated to non-surgeons. By contrast, at Beth Israel Medical Center all patient care is directed and coordinated by the cardiac surgeons so that the patient receives the best individual attention from an appropriately trained and carefully focused professional at every stage of the process. An experienced cardiac surgeon is available 24 hours a day, 7 days a week to supervise patient care and convalescence.
Before surgery, patients are interviewed, taught what to expect and they and their family are prepared by specialized nurse practitioners (NP). After discharge, these same NPs will follow up with the patient. During surgery, one of our five expert cardiac anesthesiologists induce anesthesia and then, monitor, support and awaken the patient. The heart lung bypass machine and Cell Saver are run by a team of three dedicated experts. Specially trained and certified operating room registered nurses form an integral part of the surgical team. Our ten OR nurses have many years of cardiac surgery experience. Assisting in surgery is a highly skilled and experienced Physician Assistant, or an RNFA (formerly one of our scrub nurses) who is internationally acclaimed for his technical skill in minimally invasive harvest of veins and radial arteries for use in bypass surgery.
After surgery, patients are in a dedicated cardiac surgery intensive care unit immediately adjacent to the operating room area. RNs with advanced certification and experience monitor and care for post-surgery patients (one nurse to one open heart patient) and provide support for anxious relatives. The bedside nurse reports directly to both the head nurse and to the cardiac surgeons. All critical care is provided and supervised by the team of cardiac surgeons themselves and is not delegated to anyone else.
Established relationships provide for rapid and expert advice when needed from consultants in Endocrinology (diabetes team), Infectious Disease, Renal Medicine, Pulmonary Medicine, Neurology and a full complement of sub-specialists from the medical staff at Beth Israel. Additional in-hospital backup is available from the critical care surgeons and physician assistants from the Surgical ICU.
Relatives will be invited to visit the Cardiac Surgery Intensive Care Unit (CSICU) soon after surgery is complete. The patient will (almost always) still be under anesthesia with intravenous lines and drains, which the bedside nurse will explain. When the patient is awake and stable, they will be removed from the ventilator (breathing machine) and soon after will be sitting out of bed. By the first post-operative day many monitoring lines and drains are removed and the patient may be transferred to the Step Down Unit on the 10th Floor of the Dazian Pavilion. Here, care is provided by another group of dedicated nurses and therapists, and medical care is overseen by a team of certified and experienced Adult Nurse Practitioners, with direction from the cardiac surgeons. Patients follow a goal-driven program of recovery and mobilization. The patient and their families will be educated and prepared for discharge to the further care of their referring cardiologist.
The result of our seamless and specialized team approach is clearly reflected in our patient's excellent outcomes. Despite operating on patients who are known to be at greater risk, Beth Israel Cardiac Surgery has produced results that have consistently equaled and exceeded the highest standards in the region and nationally.