Abstract
Purpose: Since 1985 patients in the St. Antonius Hospital are treated with an Implantable Cardioverter Defibrillator (ICD). In the eighties implanting an ICD was a major operation. Just like a heart operation a thoracotomy was needed, the wires of the ICD were stichted to the heart and the pulse generator itself was so big, it was placed in the abdomen. The advancing technique made ICD implantation a minor intervention. The ICD became smaller and the leads are put into placed transvenously. At present the size of the operation is comparable with the implantation of a pacemaker. As a result the admission time in hospital became shorter. It became more difficult for the nurses to inform and support the patient and his familiy properly. Moreover there is evidence that patients don't remember much of the information when they are at home again. Aim of this project is to optimalise the total care for ICD-patients. First priority was the outpatients' period, but as a result the clinical phase was restructured too.
Method: For the outpatients' period a readjustment route has been established. Before discharge the patients are informed about the possibility of a weekly set time when nurses gives consultations by telephone. Four weeks after discharge patients are contacted by telephone by a nurse to discuss their first experiences and problems. Approximately four months after dismissal every ICD patient is invited for a scheduled panelmeeting with a cardiologist, a socially worker, an ICD-technician and a nurse, where they can ask all kinds of questions. Information about an ICD is also available on the Internet site of the Heart Lung Centre Utrecht (HLCU). Furthermore the patients can ask advice of a nurse by e-mail.
Then an annual meeting is organised for all the ICD-patients and their partners, with structured information and the possibility of meeting fellow-sufferers. As a result the amount of information during the admission period is decreased.
For the clinical phase a new brochure has been developed with required information for the specific situation in our hospital. Patients then also receive a general brochure of the Dutch Heartfoundation about having an ICD.
Results: During the admission time less information is given and the information that is given now is better structured. For the outpatients there is a readjustment route available. The project has started on 1 January 2004.