Cardiac Surgery Patient Flow Protocol

1. Pre-Admission Phase

Initial Consultation

• Complete cardiac evaluation
• Review imaging and diagnostic tests
• Risk stratification (STS score calculation)
• Surgical consent discussion

Pre-operative Testing

• Standard laboratory panel
• Chest X-ray and ECG
• Cardiac catheterization (if indicated)
• Carotid duplex (age >65)
• Additional tests as clinically indicated

2. Pre-Operative Phase

Day Before Surgery

• Admission to cardiac unit
• NPO status initiation (midnight)
• Pre-operative medications review
• Skin preparation protocol
• Final consent verification

Morning of Surgery

• Vital signs and pre-op checklist
• Beta-blocker administration (if prescribed)
• Surgical site marking
• Transport to pre-op holding area

3. Operative Phase

Operating Room Flow

• Time-out procedure
• Anesthesia induction
• Procedure execution
• Documentation requirements

4. Post-Operative Phase

CVICU Transfer

• Immediate post-op orders
• Hemodynamic monitoring
• Ventilator management
• Pain control protocol

Step-Down Unit Transfer Criteria

• Hemodynamic stability
• Respiratory status
• Neurological status
• Pain management adequacy

5. Discharge Planning

Criteria for Discharge

• Stable vital signs
• Pain controlled with oral medication
• Independent ambulation
• Home care arrangements complete

Follow-up Protocol

• First post-op visit scheduling
• Medication reconciliation
• Cardiac rehabilitation referral
• Patient education completion

6. Documentation Requirements

Required Forms

• Pre-operative checklist
• Operative report
• Daily progress notes
• Discharge summary
• Follow-up appointments

7. Quality Metrics

• Length of stay monitoring
• Readmission rates
• Surgical site infection rates
• Patient satisfaction scores