Patient and family perceptions and experiences of same-day discharge following percutaneous coronary intervention and those kept overnight

Same-day discharge strategy in a heart rhythm management clinic: The patient-reported experience

BACKGROUND

Same-day discharge (SDD) has been adopted for interventional cardiology procedures, however, data on patient experience are scarce.

AIMS

To investigate patient-reported experience after various SDD electrophysiology procedures.

METHODS

Consecutive patients undergoing electrophysiology procedures, who fulfilled pre-defined eligibility criteria for SDD, completed the questionnaire before discharge. Procedures suitable for SDD included non/minimally-invasive (e.g. electric cardioversions, tilt tests) and invasive procedures (e.g. cardiac device replacements, catheter ablations). The questionnaire assessed patient experience before and during the procedure, satisfaction with the provided information and understanding of the discharge instructions.

RESULTS

The questionnaire was completed by 501 patients (57.5% men). Invasive procedures accounted for 56.7% of SDD procedures. Most patients (88.9%) described SDD as a good or quite good experience, while 95.3% would not hesitate to undergo a second SDD procedure if necessary. A direct interview with a healthcare team member was the preferred method of obtaining information. At discharge, a considerable number of patients were unsure about the provided instructions, including those related to anticoagulation. Patient-reported satisfaction did not differ between invasive and non/minimally-invasive procedures (P=0.06). However, after an invasive procedure, patients had a better understanding of discharge instructions (59.5% vs 41.9%; P<0.001). Most patients who underwent a procedure under general anaesthesia reported a good or quite good experience (87.7% vs 84.2% of sedation patients; P=0.16).

CONCLUSION

SDD was generally a positive experience for patients undergoing invasive or non/minimally-invasive procedures. However, discharge instructions and patient understanding require improvement.

Prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention: a retrospective observational cohort study using routinely collected health data

AIMS

To identify the prevalence, trends, and outcomes of same-day discharge (SDD) following elective percutaneous coronary intervention (PCI) among six public hospitals in Queensland, Australia.

METHODS AND RESULTS

A retrospective observational research design was used. A total of 4387 cases were obtained from the Queensland Cardiac Outcomes Registry and National Hospital Cost Data Collection. The two data sets were linked using identifiable data items. Patients were those who had elective PCI between December 2012 and December 2019 either discharged the same day of the procedure or the next day. Data were analysed using descriptive and inferential statistics. The overall SDD prevalence was 6.5%, with a trend increasing from 0.2% in 2013 to 9.0% in 2019. The prevalence varied at the individual hospital level. Two hospitals did not perform SDD during the study period. The remaining hospitals demonstrated variability in SDD prevalence, with the highest from one hospital being 28.2% in 2019. Almost all SDD patients experienced no complications during or following PCI within 24 h. Compared with next-day discharge, SDD reduced the length of stay by 18 h and conferred an average of $3695 cost-savings per patient.

CONCLUSION

There was limited implementation of SDD in the six public hospitals contributing data to this study. Improvement in the SDD rate could result in better hospital resource utilization and reduce low-value care. Hence, strategies to implement and promote SDD are warranted.

Safety and Efficacy of Same Day Discharge for Men Undergoing Contemporary Robotic-assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting-First Global Experience

OBJECTIVE

To investigate the feasibility, safety, and efficacy of same-day discharge (SDD) after Aquablation specifically in an ambulatory surgery center (ASC).

METHODS

A prospective cohort of men with significant BPH underwent Aquablation at a single ASC. Comprehensive preoperative assessments were conducted, including uroflowmetry, IPSS, and PVR. Aquablation was performed as morning cases by a single experienced surgeon. Following the procedure, men were assessed for immediate postoperative outcomes, including pain levels, hematuria, and voiding efficiency. Patients meeting discharge criteria were allowed to return home on the same calendar day.

RESULTS

A total of 60 consecutive men with a mean prostate size of 115 mL underwent Aquablation, 59 (98%) of whom were discharged the same day. No transfusions or return to the OR occurred. The procedure demonstrated a significant improvement in urinary flow rates and a substantial reduction in IPSS scores at the 1-month post-operative period. Pain scores were found to be minimal, and the incidence of postoperative complications, including hematuria and urinary retention was low and comparable to previously published outcomes. Despite more meticulous focal cautery, no differences in erectile, ejaculatory or adverse outcomes were observed.

CONCLUSION

Aquablation for BPH at an ASC appears to be a safe and effective approach. Morning procedures and attentive cautery and streamlined patient pathways seem essential for SDD. Despite electrosurgical hemostasis, ejaculatory, sexual, and post-operatively pain were not compromised.

Continuous nursing care improving outcomes of patients after percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is an effective method for the treatment of coronary heart disease. Cardiac rehabilitation and continuous nursing management after discharge are the key to ensure the quality of treatment and the quality of life of patients. This study aimed to explore the significance of WeChat platform in continuous care after PCI. We collected the clinical data of 90 PCI patients in 2 centers from January 2020 to July 2023, and divided the patients into 2 groups: the continuous nursing care group based on the WeChat platform and the control group. Continuous nursing care was implemented immediately after discharge. After 1-year follow-up, we compared the outcomes of the 2 groups, including postoperative complications, lifestyle changes and psychological status. There were no heart-related postoperative complications in either group. The incidence of vagal reflex was significantly decreased in the continuous nursing group (P = .042). The improvement of life style, such as smoking cessation (P = .001) and alcohol withdrawal (P = .003), was significantly better than that of the control group. The continuous nursing group was better than the control group in improving psychological status based on the Hamilton's depression scale. Continuous nursing care based on WeChat platform could reduce the incidence of complications of patients after PCI, alleviate patients' depression, and improve patients' quality of life.

Same-day discharge after percutaneous coronary procedures-Structured review and comprehensive meta-analysis

INTRODUCTION

Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. The safety and feasibility of performing these procedures on a same-day discharge basis for selected patients has been studied in a large number of mostly nonrandomized trials. An up to date literature review should focus on trials with radial access, representing the current standard for coronary procedures in Austria and other European countries.

METHODS

The aim of this consensus statement is to review the most recent evidence for the safety and feasibility of performing same-day discharge procedures in selected patients. A structured literature search was performed using prespecified search criteria, focusing on trials with radial access procedures.

RESULTS

A total of 44 clinical trials and 4 large meta-analyses were retrieved, spanning 21 years of clinical evidence from 2001 to 2022. The outcome data from a wide range of clinical settings were unanimous in showing no negative effect on early (24 h) or late (30 day) major adverse events after same-day discharge coronary procedures. Based on nine prospective trials a comprehensive meta-analysis was compiled. Using 1‑month major adverse events data the pooled odds ratio of same-day discharge versus overnight stay procedures was 0.66 (95% confidence interval, CI 0.35-01.24; p = 0.19; I2 0%), indicating a noninferiority in carefully selected patients.

CONCLUSION

Outcome data from same-day discharge coronary intervention trials with radial access confirm the robust safety profile showing no increase in the risk of major adverse events compared to overnight stay.

Same-day discharge after percutaneous coronary procedures-Consensus statement of the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology

INTRODUCTION

Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. Recent technical advances such as radial access, third generation drug-eluting stents and highly effective antiplatelet therapy have substantially improved the safety profile of coronary procedures. Despite several practice guidelines and a clear patient preference of early hospital discharge, the percentage of coronary procedures performed in an outpatient setting in Austria remains low, mostly due to safety concerns.

METHODS

The aim of this consensus statement is to provide a practical framework for the safe and effective implementation of coronary outpatient clinics in Austria. Based on a structured literature review and an in-depth analysis of available practice guidelines a consensus statement was developed and peer-reviewed within the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology.

RESULTS

Based on the available literature same-day discharge coronary procedures show a favorable safety profile with no increase in the risk of major adverse events compared to an overnight stay. This document provides a detailed consensus in various clinical settings. The most important prerequisite for same-day discharge is, however, adequate selection of suitable patients and a structured peri-interventional and postinterventional management plan.

CONCLUSION

Based on the data analysis this consensus document provides detailed practice guidelines for the safe operation of daycare cathlab programs in Austria.

Patient perspectives on same-day discharge following catheter ablation for atrial fibrillation: results from a patient survey as part of the monocentric FAST AFA trial

AIMS

Same-day discharge (SDD) following catheter ablation (CA) of atrial fibrillation (AF) was already introduced in selected facilities in Europe, but a widespread implementation has not yet succeeded. Data on patients' perspectives are lacking. Therefore, we conducted a survey to address patients' beliefs towards SDD and identify variables that are associated with their evaluation.

METHODS AND RESULTS

As part of the prospective, monocentric FAST AFA trial, patients aged ≥20 years undergoing left atrial CA for AF were asked to participate in the survey consisting of a study-specific questionnaire, the AF knowledge scale, and pre-defined patient-reported outcome measures. The study cohort was stratified based on SDD willingness, and a logistic regression analysis was used to identify predictors for patients' valuation. Between 26 July 2021 and 01 July 2022, 256 of 376 screened patients consented to study participation of whom 248 (mean age 61.8 years, 33.9% female) completed the SDD survey. Of them, 50.0% were willing to have SDD concepts integrated into their clinical course with increased patient comfort (27.5%), shorter waiting times (14.6%), and a cost-efficient treatment (14.0%) being imaginable benefits. In contrast, expressed concerns included uncertainties with occurring complaints (50.6%), the insufficient recognition (47.8%), and treatment (48.9%) of complications. European Heart Rhythm Association class at baseline and inpatient treatments within the preceding year were predictors for SDD willingness whereas comorbidity burden or AF knowledge were not.

CONCLUSION

We provide a detailed survey expressing patients' beliefs towards SDD following left atrial CA. Our findings may facilitate adequate patient selection to improve the future implementation of SDD programs in suitable cohorts.

Safety and feasibility of same-day discharge following catheter ablation of atrial fibrillation: what is known and what needs to be explored?

Catheter ablation of atrial fibrillation (AF) is the most effective rhythm control strategy and its role in the treatment of AF patients has been strengthened by recent guidelines. An increasing AF prevalence and the resulting demands on interventional electrophysiology call for improved resource allocation through both technical innovations and streamlined workflows and patient pathways. Same-day discharge is already established in the context of other electrophysiological interventions; however, its broad implementation in the practice of AF ablation is pending for several reasons, despite the fact that the body of evidence is growing and the majority of reports propagate early discharge to be feasible and safe under certain conditions. This review article is intended to provide an overview of the existing data, classify these into the specific study context, and to show limitations and open questions.

Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia

Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.

Greater Nursing Role for Enhanced Post-Percutaneous Coronary Intervention Management

Percutaneous coronary intervention (PCI) has increasingly been used in management of coronary artery diseases (CAD). Coupled that with an increasing incidence rate of CAD has augmented the hospital burden with consequential post-PCI patient management problems and dissatisfaction. Nursing care has a key role to play in upgrading the healthcare services and raising patients’ satisfaction through enhanced patient education and engagement. In this regard, nursing-led intervention has shown some success in three main domains: risk reduction; psychological improvement; and quality of life. Urgent efforts are needed to formulize a structured follow-up with enhanced nursing role in post-PCI management to raise quality of healthcare.