A SUGGESTION FOR OPTIMIZATION OF CARDIAC CARE UNIT

A SUGGESTION FOR OPTIMIZATION OF CARDIAC CARE UNIT OR CCU OF SHAHID CHAMRAN HOSPITAL (SCH’S CCU)"
MOHAMMAD REZA POOSTI
Arman Sanaat Evan Co.
poosti@ase-evan.com

MOHAMMAD MAHDI POOSTI
M2poosti@gmail.com


After a heart attack or major cardiac surgery, patients typically are treated in a hospital's cardiac care unit, or CCU, which offers highly specialized care until their condition stabilizes. A CCU contains extensive heart monitoring and testing equipment as well as a staff trained and certified in heart conditions and procedures and their aftermath. In this article we study the properties of CCU conditions, and then optimize the Sahid Chamran Hospital's CCU conditions in a minimum cost and time. This is a case study for optimization process of a Cardiac Care Unit (CCU) with 16 beds.
Keyword: Cardiac care unit, CCU, optimization
1. Introduction:
After a heart attack or major cardiac surgery, patients typically are treated in a hospital's cardiac care unit, or CCU, which offers highly specialized care until their condition stabilizes. A CCU contains extensive heart monitoring and testing equipment as well as a staff trained and certified in heart conditions and procedures and their aftermath.
Like normal ICUs, CCUs are designed to limit stress to patients during the initial, critical phase of their treatment. Visitors are typically restricted to immediate family members, and visiting hours are often limited to two or three short periods of time per day. Food and other items brought from outside the hospital, such as plants and flowers, are usually prohibited as well. Patients in CCUs tend to be on supervised diets, and plants can introduce potential infection-causing bacteria into the environment.
Often, patients are hooked up to wires and tubes during their CCU stays, which can prove disconcerting to family members, but is necessary for close monitoring.
2. Properties of Cardiac Care Unit
Three general properties as environment, personnel, and equipment are CCU properties. We will explain more in detail in next sections.
1-2. Environment
This is a 12-15 bed specialty unit equipped with state-of-the-art monitoring equipment required surgery where patients recover after heart surgery. The CCU also cares for patients with a present or potentially life-threatening condition. All patients are connected to heart monitors, and some patients
Also require ventilators to assist their breathing. There is monitoring equipment around each bed. This is normal for this kind of unit and enables nursing staff to constantly monitor heart rhythms and other important signs, such as blood pressure and oxygen levels. Information is sent to a central monitor so staff can still see this even when not at the bed side. CCU is designed in circle or U shape where the nursing station is located in the middle for good observation and monitoring.
2-2. Equipments
All patients are connected to heart monitors, and a variety of tests are often done during a stay in the CCU, such as blood work or electrocardiograms, which measures the electrical activity of the heart. Many different cardiac medications may be given, including those to treat heart failure or to reduce the workload of the heart. Many medical devices, including heart monitors and respirators, emit periodic beeps and buzzes, and the around-the-clock movement of medical personnel through the unit can make the CCU less restful than intended.
3-2. Personnel
The nursing staff receives specialized training in the care of patients with cardiac arrhythmias, chest pain, heart failure and other critical medical conditions. They use state-of-the-art technology to meet the needs of the patient population.
Following are some characters which nurses must meet them in CCU. Job training, quick reflex to patient, quick treatment power, and… are some other characters which a nurse has. Table-1 displays all important characters of nurse in CCU.
1-3-2. Emotional stability
Emotionally stable persons tolerate minor stresses and strains of day to day living without becoming emotionally upset, anxious, nervous, tense, or angry. They are able to maintain composure under minor emotional stress. They are fairly constant in their basic mood, and they generally revert quickly to that state following those occasions when they have experienced considerable stress or have been exceptionally provoked. The unstable person, in the other word, is subject to fairly wide, frequent, and often unpredictable mood shifts that may swing from pole to pole.
They need emotional stability to cope with human suffering and frequent emergencies. They must be able to accept responsibility, provide direction to others, coordinate a patient’s health care plan, and collaborate with other health care professionals.
2-3-2. Social maturity
Full-stress events in CCU environment can make more challenges between medical team, nurses, and patients relatives. Nurses must be able to interact well with all kinds of people in difficult situations. Social maturity helps nurses having a logical and suitable behavior against all above situations.
3-3-2. Motivation
Motivation is the internal condition that activates behavior and gives it direction; energizes and directs goal-oriented behavior. In Nursing Management, staff needs to be motivated to have quality patient care, to develop staff efficiency and to reduce absenteeism. These make the person work with enthusiasm & interest.
4-3-2. Knowledge
Nurses with a better understanding of how to overcome healthcare disparities; care for patients suffering from post-traumatic stress disorder (PTSD) and from side effects of bariatric surgery; further themselves and the profession through publishing; and share in the experience of a nurse.
5-3-2. Integrity
The concept of integrity is directly linked to responsibility in that implementation spawning from principles is designed with a specific outcome in mind. When the action fails to achieve the desired effect, a change of principles is indicated. Accountability is achieved when a faulty principle is identified and changed to produce a more useful action.
6-3-2. physical and mental health
Because of CCU activities conditions, physical ability and mental health are two important characters. CCU manager must try to hire nurses with more mental health and physical abilities.
Table-1 displays all important properties which a CCU must meet them, and we discussed about some of the important ones.






Table -1: Sh. Chamran Hospital's CCU properties
Item(s) Property No.
Height ٍ


Environmentٍ


1

Air-conditioning
Lighting
Landscape design
Vinyl floor tile
Interior design
Number of bed
Knowledge

\personnel


2
Job training
Age
Quick reflex to patient
Quick treatment power
Emotional stability
Social maturity
Motivation
Physical and mental health
Integrity
Required equipment ٍEquipment 3
3. Sh. Chamran hospital's Cardiac Care Unit (CCU)
SCH's CCU is Located on first floor of the main building of SCH. The Cardiac care units provide care to patients with a variety of cardiac illnesses and other critical medical issues. The nursing staff receives specialized training in the care of patients with cardiac arrhythmias, chest pain, heart failure, and other critical medical conditions.
They use state-of-the-art technology to meet the needs of the patient population. SCH's CCU contains 16 beds which are distributed on 16 open rooms. Every room is a high care environment with a higher ratio of nurses to patients than on a general ward. There is monitoring equipment around each bed. This is normal for this kind of unit and enables nursing staff to constantly monitor heart rhythms and other important signs, such as blood pressure and oxygen levels. Information is sent to a central monitor so staff can still see this even when not at the bed side.
There are alarms on the equipment that may sound from time to time they do not always indicate a problem. A three side room with a 15 square meters contains each bed. The open side is covered by a curtain. The general view of room is illustrated in Fig-1.

Fig-1: SCH's CCU room before changing
Visiting time is, 2pm to 4pm daily. This allows patients the rest required and time for investigations, nursing and medical care. Mobile phones are not permitted at any time due to possible interference with the Unit’s equipment. SCH's CCU is designed in circle shape where the nursing station is located in the middle for good observation and monitoring. (Fig. 2)

Fig. 2: General shape of SCH's CCU
Point A is nurse station; B and C are two extra stations. The arrows in corner of Fig-2 show SCH's CCU entrance doors.
Nursing activities will do 24 hours which is divided by three shifts.
Morning shift: 7:00 a.m. to 2:00 p.m.
Evening shift: 1:30 p.m. to 7:30 p.m.
Night shift: 7:30 p.m. to 7:30 a.m. (next day)
4. Background
We searched all Phd thesises which are stored in Great National Library of Iran, but we found one research which was comparison of depression between patients in CCU and Optic department of Amir-Kabir hospital. Refference #4 shows the title which we found. It has not included relevance topics to our research.It shows nobody has studied in this case, and it’s a new topic. Data collection has done by nurses and CCU staff, and we analyze them. The results sent to CCU staff and hospital manager.
5. Optimization process of SCH's CCU
We searched all CCU's properties which it is required for a hospital CCU. We categorized properties into three general items, and then divided them by some details. Table -1 is illustrated all properties and their details. Environment includes 7 items, personnel have 10 items, and we considered equipment as an item (Table -1).Table- 1 displays all properties and details which a Hospital's CCU has. Because of having the weight of each properties, it's designed a questionary which is included all CCU properties, and we asked nurses and staff which worked in SCH's CCU fill the questionary with the weight of each items from 1 to 10. The result is illustrated in table-2, and the average weight is shown in last column.
Table-2: The weight of SCH's CCU properties
Average Property weight Item(s) Property No.
6 6 7 7 6 Height


Environmentٍ



1

3.85 2 3 3 7 Air-conditioning
3.85 5 3 3 4 Lighting
2 3 0 0 5 Landscape design
9 9 8 10 9 Vinyl floor tile
6/25 9 4 10 2 Interior design
4/75 2 4 7 6 Number of bed
9 6 10 7 9 Knowledge


\personnel


2
25/7 6 7 8 8 Job training
75/8 8 10 7 10 Age
25/7 7 8 8 7 Quick reflex to patient
25/8 7 9 8 9 Quick treatment power
75/7 6 8 9 8 Emotional stability
5/7 5 9 8 8 Social maturity
5/4 6 5 5 3 Motivation
8 7 8 8 8 Physical and mental health
9 9 9 9 8 Integrity
5/8 8 7 7 9 Required equipment ٍEquipment 3
Fig-3 is illustrated the spider diagram of weighted items which we have collected through nurses questionary.

Fig-3: Spider diagram of SCH's CCU properties
6. Analysis
Referring to Table-2, the minimum weight is belonged to following items:
- Landscape design
- Air-conditioning
- Lighting
We try to optimize the above items, in other hand the weight of those must increased. The procedure is following:
1-6. Landscape design and Lighting
There is a very spread and beautiful garden behind of the SCH's CCU, but no communication is between garden and CCU, except a small window (blue background behind of window is symbol of garden in Fig-1). Because of having light more than before, good view, and communication with the garden, we change the size of window, and increase the room area. One of the SCH's CCU room is illustrated before of changing in Fig-1. A corridor with a 1.5 meter in width is behind of SCH's CCU rooms, and there is a very beautiful garden behind of corridor.
First, we change size of corridor windows, and then, increase the rooms' size. Increasing the size can be done room by room, and in minimum time. Fig-4 shows the SCH's CCU after changing.


Fig-4: SCH's CCU room after changing
2-6. Air-conditioning
16 visitors visit patients every 5 minutes during visiting time (2:00 to 4:00 p.m.); it means 190 persons in hour and 380 persons totaly visit patients in SCH's CCU. This causes temperature increasing about 2-3 degrees through visiting time. For stabilizing the temperature before and after visiting, it can decrease the temperature about 2 degrees less,15 minutes before visiting time. The temperature setting can back to its normal setting when the visiting time is over.
3-6. Entrance door
The entrance doors of SCH's CCU are manual, which it makes troubles for CCU's personnel, and also heat losses increases. An automatic door facilitates entrance and protects CCU against heat losses.
4-6. Direction panel
Because of importance and sensitivity of CCU's patients, visitors must consider some points during their presence in CCU such as following:
1-4-6. Mobile phones are not permitted.
2-4-6. Young children are not allowed brought to visit
3-4-6. Individual circumstances regarding this and visiting times can be discussed with a member of nursing staff
4-4-6. please don’t say any excited news to patients
These directions are followed by nurses, staff, and all personnel, but a visual directory table can help visitors for considering all directions which the medical team likes to apply in CCU environment. There are no direction tables.
7. Conclusion
Except changing the size of rooms, all suggestions which we explained in optimization process (section 5), can do without any disturbing in SCH's CCU activities. No interrupts or operation gap is needed. The situation of SCH's CCU after optimization process is illustrated in Fig-5. It shows spider diagram of SCH's CCU situation after optimization.


Fig-5: The SCH's CCU situation after optimization
The result shows, SCH's CCU has increased 50% in operational properties through the optimizing process in the mean time and minimum cost.
References:
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2. شيري حسين، نيك روان مفرد فلاحت، " كاملترين مرجع اصول مراقبتهاي ويژه در CCU ،ICU و دياليز"، انتشارات نور دانش، 1385
3. سادات بصام پور شيوا، اسدي نوتابي احمدعلي، ذوالفقاري ميترا، " مراقبت هاي پرستاري ويژه ICU و CCU و دياليز"، نشر سالمي، چاپ دوم 1386، تهران.
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Web sites sources:

http://dictionary.babylon.com/Emotional_stability
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http://news.nurse.com/apps/pbcs.dll/article?AID=
AUTHOR BIOGRAPHIES
Mohammad Reza Poosti was born in 1963. He has graduated in MBA from CARLETON University (Canada-2006) and Bsc in mechanical engineering in 1992(Tehran- science and technology university). His main experience is instruments manufacturing and management research. He has published some papers in Iran, Asia, and USA conference and symposium.he is general manager of Arman Sanaat Evan (www.ase-evan.com) since 2008. His e-mail address is: poosti@ase-evan.com