1. Clinical and health promotion partnerships support cardiothoracic surgical patient recovery
Brittany Marsh, Simon Renshaw, Casey Nottage, Carolyn Astley, Rachel McKay, Imelda Lynch
Brittany Marsh
Clinical Project Officer
Heart Foundation

2. Background
After cardiac surgery, deep breathing and coughing exercises are encouraged to restore lung functions back to normal.
Doctors and physiotherapists suggest applying pressure to the sternum during such exercises to alleviate pain and discomfort.
This is usually done by using a normal bed pillow or rolled up/folded towels.
Current hospital practices for supporting the sternum during coughing and breathing exercises are varied and often depend on the patient and what the hospital has access to.
Anecdotal reports of current practices include:
Using rolled up or folded towels often in a pillow case. This doesn’t cover the same surface area as a pillow, resulting in less stability. Also they aren’t as comfortable or easy to use as a pillow.
Using normal bed pillows. For many people they are too big and don’t provide the right support as patients tend to struggle to get their arms around them.
Providing handmade heart shaped pillows. However feedback is that hospitals find it a time consuming activity to engage sewing groups and source material, and are struggling to keep up with demand. Whilst often planned as a fundraising activity for the hospital or unit, most hospitals are not making any profit, nor selling many heart shaped pillows. In most hospitals they are not currently being provided.
The patient using their hands. However anecdotal feedback from the Royal Adelaide is that approximately 80% of patients use a pillow or towels.        
There is an opportunity to support cardiothoracic surgical patients in their recovery by producing a Heart Foundation heart shaped pillow or standard size pillow case that they can use to support their sternum when doing deep breathing and coughing exercises.

3. Background

4. Background
Cardiothoracic surgery commonly includes coronary artery bypass grafting and heart valve repair and replacement.
In SA this is approximately 1,500 patients per year.
Nationally it is 21,270 patients per year.
Across 6 metropolitan hospitals

5. Objectives
Support cardiothoracic surgical patients in their recovery with a Heart Foundation heart shaped pillow to support their sternum when doing deep breathing and coughing exercises.
Raise awareness of the Heart Foundation Helpline, with cardiothoracic surgical patients as an organisation that can support them and their families in their recovery.
Determine whether the HF pillow was effective in supporting …
And whether through distribution of the pillows we were able to…

6. Heart Foundation Helpline
The Heart Foundation Helpline provides free personalised information and support on heart health, nutrition and a healthy lifestyle. Unable to provide individual clinical advice/individualized clinical care. Callers directed to health professionals.
Serviced by experienced heart health professionals, mostly nurses with acute sector experience. Additional service to patients individual health care professionals/services
National service, run out of Adelaide, Aus. Provides support to the community
Cost of a local call

7. Method
The Heart Foundation designed and produced a Cardiac Cough Pillow with the Heart Foundation’s Helpline phone number printed on the cover.
These pillows are single patient use, washable and compliant with hospital infection control policies.
Piloted in SA

8. Implementation of survey
Methods
Recruitment of 1 public and 1 private hospital in SA
Extension of existing relationship of My heart, my life
Historical use of cough pillow
Hospital engagement
Ethics approval obtained from each hospital’s human research ethics committees
Ethics
Eligible patients identified, recruited, consent gained
Patients requested to compare the Heart Foundation pillow with a bed pillow or rolled towel, when doing their deep breathing and coughing exercises
Sample of 180 patients
Patient recruitment
Hospital engagement- nurse champion
Pt recruitment- informed consent
Prior to completing survey pts required to use pillow at least 1
Supported by nursing staff, patients completed the satisfaction survey
Implementation of survey
Descriptive statistics
Open text responses described narratively
Analysis

10. 177 patient satisfaction surveys were received
Demographic data collected- age, average age was 66, most common procedures bypass and valve surgery

11. Implementation of survey
Methods
Recruitment of 1 public and 1 private hospital in SA
Extension of existing relationship of My heart, my life
Historical use of cough pillow
Hospital engagement
Ethics approval obtained from each hospital’s human research ethics committees
Ethics
Eligible patients identified, recruited, consent gained
Patients requested to compare the Heart Foundation pillow with a bed pillow or rolled towel, when doing their deep breathing and coughing exercises
Sample of 180 patients
Patient recruitment
Analysis- quantitative data we did basic descriptive statistics (i.e. proportions) and for an open text responses we described these narratively
Supported by nursing staff, patients completed the satisfaction survey
Implementation of survey
Descriptive statistics
Open text responses described narratively
Analysis

12. Methods

13. Results
Demographic data collected- age, average age was 66, most common procedures bypass and valve surgery
Pain using HF pillow – 4.6/10
Pain using hospital pillow/towel- 5.5/10

14. Results Pain using HF pillow – 4.6/10
Pain using hospital pillow/towel- 5.5/10

15. Results

16. Results
87% of patients reported the pillow was is effective in helping with their recovery from surgery.
81% of patients reported they would call the Heart Foundation Helpline.
51% of patients requested a call from the Heart Foundation Helpline after they returned home.

17. 60% patients provided comments / feedback / suggestions
Results
60% patients provided comments / feedback / suggestions
75% positively described the design and physical and psychological impact of the pillow
8% provided suggestions for improvements
From the narrative description of open text this is what we saw…

18. Outcomes Common positive comments…
“Found little pillow extremely comfortable. These days nurses don’t seem to be able to hold your hand, or wipe your brow, like they could years ago. The pillow helps with this comfort”
“The cardiac cough pillow has been an extremely valuable piece of recovery. Highly recommend this pillow”
“Having the heart pillow gives invaluable support and back up during your worst times”

19. Outcomes “I would like to see different colours”
Suggested improvements…
“I would like to see different colours”
“Perhaps a small grip/handle would be helpful in accessing a pillow from difficult patient position”
“Could be a little longer”

20. Implications for practice
The Heart Foundation Cardiac Cough pillow provides effective support to patients post cardiothoracic surgery.
The Heart Foundation Cardiac Cough pillow is an impactful way to engage cardiothoracic surgical patients with the Heart Foundation and the Heart Foundation Helpline.
In SA rolling out to other hospitals currently we have 3 hospitals on board. About 100 distributed since pilot completed (goal all 6 hospitals in SA)