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Hyasat K, Femia G, Alzuhairi K, Ha A, Kamand J, Hasche E, Rajaratnam R, Lo S, Almafragy H, Liou K, Chiha J, Asrress K. Safety, Feasibility and Economic Analysis of Same Day Discharge Following Elective Percutaneous Coronary Intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221116852. [PMID: 36046181 PMCID: PMC9421009 DOI: 10.1177/11795468221116852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Background Advances in percutaneous coronary intervention (PCI) has made the possibility of facilitating same day discharge (SDD) of patients undergoing intervention. We sought to investigate the feasibility, safety and economic impact of such a service. Methods We retrospectively collected data on all patients undergoing outpatient PCI at our institution over a 12-month period. We included in-hospital and 30-day major adverse cardiac events (MACE), vascular complications, acute kidney injury and any re-hospitalisations. We analysed the cost effectiveness of SDD compared to overnight admission post PCI and staged PCI following diagnostic angiography. Results A total of 147 patients undergoing PCI with 129 patients deemed suitable for SDD (88%). Mean age was 65.7 years. Most patients had type C lesions (60.3%); including 4 chronic total occlusions (CTOs). At 30-day follow-up there were no MACE events (0%). There were 10 (7.8%) re-hospitalisations of which majority (70%) were non cardiac presentations. We also included cost analysis for an elective PCI with SDD, which equated to $2090 per patient (total of $269 610 for cohort). Elective PCI with an overnight admission was $4440 per patient (total of $572 760 for cohort), an additional $2350 per patient (total $303 150). Total cost of an angiogram followed by a staged PCI with an overnight stay was $4700 per patient (total $606 300). Conclusion SDD is safe and feasible in the majority of patients that have elective coronary angiography that require PCI. SDD leads to a significant reduction in total cost and hospital stay of patients undergoing elective PCI.
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Affiliation(s)
- Kais Hyasat
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Karam Alzuhairi
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Andrew Ha
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Joseph Kamand
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Edmund Hasche
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Rohan Rajaratnam
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Hamid Almafragy
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Kevin Liou
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Joseph Chiha
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Kaleab Asrress
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
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Koutouzis M, Liontou C, Xenogiannis I, Tajti P, Tsiafoutis I, Lazaris E, Oikonomidis N, Kontopodis E, Rangan B, Brilakis E. Same day discharge after chronic total occlusion interventions: A single center experience. Catheter Cardiovasc Interv 2021; 98:1232-1239. [PMID: 33048434 DOI: 10.1002/ccd.29320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the feasibility and safety of same day discharge (SDD) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND CTO PCI has been associated with higher complication rates and procedural and hospitalization costs. Shortening post-PCI hospitalization length not only increases the patients' comfort but at the same time it consists an important part of cost reduction policies. METHODS We retrospectively compared the 30-day outcomes of patients who underwent CTO PCI at the Red Cross Hospital, Greece between January 2016 and June 2019 and underwent SDD versus non-SDD. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction, urgent repeat target vessel revascularization, tamponade, and stroke. RESULTS A total of 173 patients (mean age 63.7 ± 8.9 years) were included, of whom 51 (30%) underwent SDD. SDD patients were less likely to have diabetes mellitus (51 vs. 31%, p = .015), arterial hypertension (89 vs. 67%, p < .001), and acute coronary syndrome presentation (39.7 vs. 21.6%, p = .022), compared with non-SDD patients. Forearm access was used in all SDD patients and in 83% of the non-SDD patients. The 30-day incidence of MACE was 0% in the SDD group and 1.6% in the non-SDD group. Multivariable analysis showed that diabetes mellitus and longer procedural time were associated with lower probability of SDD (OR: 0.34, 95% CI: 0.15, 0.73 and OR: 0.29, 95% CI: 0.12, 0.71, respectively). CONCLUSIONS SDD appears to be feasible and safe in selected patients undergoing an uncomplicated CTO PCI through forearm approach.
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Affiliation(s)
| | | | - Iosif Xenogiannis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Peter Tajti
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | | | | | | | - Bavana Rangan
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Emmanouil Brilakis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Cost-effectiveness and Outcomes with Early or Same-Day Discharge After Elective Percutaneous Coronary Intervention. Curr Cardiol Rep 2020; 22:42. [PMID: 32430629 DOI: 10.1007/s11886-020-01286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Shorter hospital stay after percutaneous coronary intervention (PCI) can provide economic advantage. Same-day discharge (SDD) after transradial PCI is thought to reduce the cost of care while maintaining the quality and safety. This review summarizes the current knowledge of the benefits and safety of this concept. RECENT FINDINGS Increase in rate of transradial PCI over the last two decades has resulted in recent growth in rate of acceptance of SDD after a successful procedure. SDD is shown to result in savings of $3500 to $5200 per procedure with comparable adverse event rate of traditional discharge processes. SDD after PCI is shown to be safe and results in cost advantage maintaining the safety profile. The acceptance rate of SDD is still not optimum, and further market penetration of SDD practice would be achieved only if the institutional and operator preference barriers are addressed.
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Koutouzis M, Karatasakis A, Brilakis ES, Agelaki M, Maniotis C, Dimitriou P, Lazaris E. Feasibility and safety of same-day discharge after complex percutaneous coronary intervention using forearm approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:245-249. [DOI: 10.1016/j.carrev.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 01/29/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
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Chen Y, Marshall A, Lin F. Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review. Worldviews Evid Based Nurs 2016; 13:371-379. [PMID: 27171576 DOI: 10.1111/wvn.12163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.
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Affiliation(s)
- Yingyan Chen
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Andrea Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalized Patients (NCREN), Menzies Health Institute Queensland; Gold Coast Hospital and Health Service, Nursing and Midwifery Education and Research Unit, all at Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Frances Lin
- Program Director, Senior Lecturer, School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Clavijo LC, Cortes GA, Jolly A, Tun H, Mehra A, Gaglia MA, Shavelle D, Matthews RV. Same-day discharge after coronary stenting and femoral artery device closure: A randomized study in stable and low-risk acute coronary syndrome patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:155-61. [DOI: 10.1016/j.carrev.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
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Safety and Efficacy of Same-Day Discharge Following Elective Percutaneous Coronary Intervention, Including Evaluation of Next Day Troponin T Levels. Heart Lung Circ 2015; 24:368-76. [DOI: 10.1016/j.hlc.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 12/22/2022]
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Brayton KM, Patel VG, Stave C, de Lemos JA, Kumbhani DJ. Same-Day Discharge After Percutaneous Coronary Intervention. J Am Coll Cardiol 2013; 62:275-85. [DOI: 10.1016/j.jacc.2013.03.051] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/27/2013] [Accepted: 03/13/2013] [Indexed: 12/29/2022]
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Antonsen L, Jensen LO, Thayssen P. Outcome and safety of same-day-discharge percutaneous coronary interventions with femoral access: a single-center experience. Am Heart J 2013; 165:393-9. [PMID: 23453109 DOI: 10.1016/j.ahj.2012.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/11/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ongoing development in percutaneous coronary intervention (PCI) techniques and closing devices facilitates same-day-discharge in patients undergoing uncomplicated PCI procedures. We examined the safety and outcome in low-risk patients discharged the same day as PCI with femoral access was performed. METHODS From January 1, 2010, through December 31, 2010, the outcomes of same-day discharge in 355 (19.6%) of in total 1,809 patients undergoing PCI were analyzed. Composite end point included major adverse cardiac or cerebral events and/or bleeding/vascular complications within 24 hours and 30 days. Major adverse cardiac and cerebral events were defined as cardiac death, myocardial infarction, stroke, coronary artery bypass grafting, or repeat PCI. RESULTS The mean age of the study population was 64.5 years (40.0-93.0 years), 17.3% of the patients were ≥75 years old. The indication for PCI was: stable angina pectoris (n = 277, 78.0%) and unstable angina pectoris/non-ST-segment elevation myocardial infarction (n = 78, 22.0%). In all patients femoral access was used, and the puncture site was closed with the closing-device AngioSeal. No major adverse cardiac and cerebral events were seen within 24 hours or 30 days except in 1 patient who had target lesion revascularization done as PCI 4 days post-procedure. Three patients had bleeding/vascular complications; 2 patients were re-admitted within 24 hours due to access-site hematomas, which were treated with manual compression and bed-rest regimes. One patient developed a pseudoaneurysm within 12 hours post-procedure. CONCLUSIONS Same-day-discharge after uncomplicated PCI using femoral access is safe when patients are properly selected. The strategy may improve and benefit health costs in the future.
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Affiliation(s)
- Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Ambulatory transradial percutaneous coronary intervention: A safe, effective, and cost-saving strategy. Catheter Cardiovasc Interv 2012; 81:15-23. [DOI: 10.1002/ccd.24545] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 05/06/2012] [Indexed: 12/29/2022]
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Safety of same day discharge following percutaneous coronary intervention. Heart Lung Circ 2011; 20:353-6. [PMID: 21429794 DOI: 10.1016/j.hlc.2011.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 01/25/2011] [Accepted: 01/26/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a body of literature reporting the safety of discharging patients the same day as percutaneous coronary revascularisation. Nevertheless, overnight stay continues to be the general standard of care. METHODS Over a single calendar year, 130 patients having elective, percutaneous coronary revascularisation were discharged home the day of the procedure with the majority of procedures using radial access. Patients were observed post procedure for six hours and if no problems occurred, discharge was undertaken. The purpose of the study was to assess complications in the 24 hours following discharge. RESULTS Within the following 24 hours post discharge, there were no complications reported including bleeding, recurrent ischaemia, or hospitalisation. CONCLUSION Same day discharge following elective percutaneous revascularisation appears both efficacious and safe with a low risk of post discharge complications.
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Self-Care Behaviour and Factors Associated with Patient Outcomes Following Same-Day Discharge Percutaneous Coronary Intervention. Eur J Cardiovasc Nurs 2009; 8:190-9. [DOI: 10.1016/j.ejcnurse.2008.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 12/11/2008] [Accepted: 12/15/2008] [Indexed: 11/20/2022]
Abstract
Background: The demand for percutaneous coronary intervention (PCI) exerts constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and improve access to care. Aim: The purpose of this study was to describe elective same-day discharge PCI patients' self-care behaviour in the two to five days following their procedure, and the factors associated with cardiac self-efficacy (CSE) and self-care agency (SCA). Methods: Using a cross-sectional correlational design, 98 consecutive patients were contacted by telephone, following PCI, and asked about their CSE, SCA, and adherence to discharge recommendations. Associations between selected variables were explored through multiple regression analysis. Results: The findings revealed a high degree of adherence to discharge recommendations, although participants' appreciation of the long term management of their chronic disease was limited. Factors associated with lower levels of CSE and SCA included the burden of having additional chronic co-morbidities, living alone and lacking social support, and a positive screening for psychosocial distress. Conclusion: Same-day discharge PCI presents a sustainable option for delivery of care for most patients. Some clients may require additional support to manage the transition between acute intervention and chronic disease management.
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Ziakas A, Klinke P, Mildenberger R, Fretz E, Williams M, Siega AD, Kinloch D, Hilton D. Safety of Same Day Discharge Radial PCI in Patients Under and Over 75 Years of Age. Int Heart J 2007; 48:569-78. [DOI: 10.1536/ihj.48.569] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Peter Klinke
- Department of Cardiology, Royal Jubilee Hospital
| | | | - Eric Fretz
- Department of Cardiology, Royal Jubilee Hospital
| | | | | | | | - David Hilton
- Department of Cardiology, Royal Jubilee Hospital
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Abstract
BACKGROUND Traditional endoscopy center scheduling often results in nonurgent inpatient endoscopic procedures being delayed until late in the day and can prolong length of hospital stay and costs. We report the first controlled study designed to evaluate the effect of an early morning fast-track triage endoscopy unit on the cost and length of stay of a general GI inpatient population. METHODS A case-control methodology matched a cohort of patients undergoing morning triage procedures with historical controls that underwent standard add-on scheduling endoscopy. Outcome indices and patient quality of care measures were compared between cases and controls. RESULTS Analysis of patients most likely to benefit from rapid endoscopy showed significant advantage comparing fast-track endoscopy patients to controls in time to endoscopy (0.63 vs. 1.00 days, P = 0.01), length of stay (1.22 vs. 1.78 days, P = 0.05), and hospital costs (2,793 dollars vs. 3,586 dollars, P = 0.02). CONCLUSIONS When routine endoscopy is the rate-limiting step for hospital discharge in the general GI patient, early morning scheduling with a reserved time and space for inpatient endoscopy is a cost-minimizing factor in a busy endoscopy center that may save significant hospital costs while preserving optimal patient outcomes.
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Affiliation(s)
- Patrick G Northup
- Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA 22908, USA.
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