Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin, Amit P.; Crimmins‐Reda, Patricia; Miller, Steven B.; Rahn, Brandon; Caruso, Mary; Pierce, Andrew; Dennis, Brandy; Pendegraft, Marissa; Sorensen, Katrine; Kurz, Howard I.; Lasala, John M.; Zajarías, Alan; Bach, Richard G.; Kulkarni, Hemant; Singh, Jasvindar

doi:10.1161/jaha.117.005733

Cited by 36 publications

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“…In a recent study from Barnes Jewish Hospital (St Louis, Missouri) in which we observed a cost savings of approximately $7000 per case of SDD, more than half of the SDD patients actually underwent femoral access, using 85% vascular closure devices. 17 In this study, SDD after femoral access resulted in slightly lower, but still substantial cost savings of $5095 per case.…”

Section: Discussionmentioning

confidence: 60%

“…As hospitals face increasing pressure to provide safe and effective health care at a lower cost, SDD has been described as one strategy to improve the value of PCI. 17 To our knowledge this is the first and only study of contemporary SDD practice in the United States that builds on prior studies of SDD with 3 novel observations. First, not only was the rate of SDD low with a weakly increasing trend, but there was also substantial variation in the practice of SDD across US hospitals, indicating that SDD practices in the United States are essentially random and likely driven by the local culture rather than evidence-based practices.…”

Section: Discussionmentioning

confidence: 95%

“…In a recent study from Barnes Jewish Hospital, we found that developing a "patient-centered" protocol for SDD based on patients' predicted risks of complications, such as bleeding and AKI, led to a rapid adoption of SDD in more than 70% of patients undergoing elective PCI and was associated with a $1.8 million cost savings annually in hospitalization costs. 17…”

Section: Discussionmentioning

confidence: 99%

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Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes

et al. 2018

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IMPORTANCE Same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is associated with lower costs and preferred by patients. However, to our knowledge, contemporary patterns of SDD after elective PCI with respect to the incidence, hospital variation, trends, costs, and safety outcomes in the United States are unknown. OBJECTIVE To examine (1) the incidence and trends in SDD; (2) hospital variation in SDD;(3) the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI; and (4) hospital costs of SDD and its drivers. DESIGN, SETTING, AND PARTICIPANTS This observational cross-sectional cohort study included 672 470 patients enrolled in the nationally representative Premier Healthcare Database who underwent elective PCI from 493 hospitals between January 2006 and December 2015 with 1-year follow-up.EXPOSURES Same-day discharge, defined by identical dates of admission, PCI procedure, and discharge. MAIN OUTCOMES AND MEASURES Death, bleeding requiring a blood transfusion, AKI and AMI at 30, 90, or 365 days after PCI, and costs from hospitals' perspective, inflated to 2016. RESULTS Among 672 470 elective PCIs, 221 997 patients (33.0%) were women, 30 711 (4.6%) were Hispanic, 51 961 (7.7%) were African American, and 491 823 (73.1%) were white. The adjusted rate of SDD was 3.5% (95% CI, 3.0%-4.0%), which increased from 0.4% in 2006 to 6.3% in 2015. We observed substantial hospital variation for SDD from 0% to 83% (median incidence rate ratio, 3.82; 95% CI, 3.48-4.23), implying an average (median) 382% likelihood of SDD at one vs another hospital. Among SDD (vs non-SDD) patients, there was no higher risk of death, bleeding, AKI, or AMI at 30, 90, or 365 days. Same-day discharge was associated with a large cost savings of $5128 per procedure (95% CI, $5006-$5248), driven by reduced supply and room and boarding costs. A shift from existing SDD practices to match top-decile SDD hospitals could annually save $129 million in this sample and $577 million if adopted throughout the United States. However, residual confounding may be present, limiting the precision of the cost estimates.CONCLUSIONS AND RELEVANCE Over 2006 to 2015, SDD after elective PCI was infrequent, with substantial hospital variation. Given the safety and large savings of more than $5000 per PCI associated with SDD, greater and more consistent use of SDD could markedly increase the overall value of PCI care.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes

et al. 2018

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“…Acute myocardial infarction is an important cause of morbidity and mortality in the developing 1, 2 3, 4 world [1]. Percutaneous coronary intervention is a common cardiovascular procedure [2]. Primary percutaneous coronary intervention, a mechanical intervention that enables restoration of blood flow by reopening the occluded artery via a catheter with an inflatable balloon, is currently the preferred reperfusion option for acute myocardial infarction with STsegment elevation [3].…”

Section: Introductionmentioning

confidence: 99%

Diurnal Variation in Outcomes of Percutaneous Coronary Intervention

Malik

Javed

2020

Cureus

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To determine whether the outcomes differ during regular hours as compared to off hours in patients with acute myocardial infarction who undergo primary percutaneous coronary intervention. Methods We conducted a prospective, interventional study of patients who presented to a specialized cardiac care center. Patients who satisfied the inclusion and exclusion criteria were included in the study. They were divided into two groups so that one group received intervention during regular working hours while the other group received intervention during 'off' hours. The data was collected through a self-constructed questionnaire. Cronbach's alpha was used to assess the internal consistency of the questionnaire, and it was found to be 0.75. The data obtained was analyzed on IBM's Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, Armonk, NY). Results Out of 100 participants, 64 (64%) were males and 36 (36%) were females. The mean age of the participants was 58.58 ± 13.21 years. Most (44%) of the patients were diabetic. Inferior wall myocardial infarcts were more common in our study. Percutaneous intervention during 'off' hours was associated with more adverse outcomes. The differences in gender and angina requiring revascularization were statistically significant (p-value<0.05). Conclusion No significant difference in outcomes was observed in both groups of patients. Metacentric data from different institutes should be gathered for a comprehensive insight on this topic where door-to-balloon times and initiation of catheterization lab procedures are practiced in different ways.

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“…7 SDD also enhances hospital resources efficiency, 8 improves cost-effectiveness, and increases patient satisfaction. 9 Despite this, implementation of SDD remains variable worldwide. 10 While the evidence for the safety and effectiveness of SDD is well described in the literature, there is little reported which can be used to help guide the implementation of SDD within complex healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Lessons learnt from the implementation of same-day discharge after percutaneous coronary intervention

Chen

Marshall

Lin

2019

Australian Critical Care

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Background: Change in healthcare organisations is constant and requires adequate resources for effective implementation. Same-day discharge after percutaneous coronary intervention has been found to be no different from the patients who stayed overnight after procedure; however, its uptake remains low. Objectives: The aim of the study was to identify what factors helped or hindered the implementation of same-day discharge. Methods: This interpretive study was conducted in a cardiac catheterisation suite of an Australian tertiary hospital between June and December 2016. Semistructured individual interviews with 26 healthcare professionals were conducted to explore the factors that influenced the implementation. A deductive approach to content analysis was guided by the theoretical domains framework. Findings: Five domains, including beliefs about consequences, professional role and identity, resources, behaviour regulation, and optimism, were identified which were strongly related to the factors that impacted the implementation. The findings showed that participants believed same-day discharge benefits while also concerning about its safety and holding different opinions on eligibility criteria. The findings also showed that participants' involvement in the change process varied with no clear roles and responsibilities and that their understanding about same-day discharge evidence and the guideline also differed. Lack of dedicated resources was also identified as the hindrance to the implementation. Behaviour regulation domain depicted how communication was managed and how the care for same-day discharge patients was improved. Despite several issues identified, participants were optimistic with achievement. Discussion and conclusion: This study has provided valuable insight into the factors that influenced the implementation, which will inform policymakers when designing interventions for future improvement. Plan for change and involvement of all stakeholders along with dedicated resources including time, people, and change management expertise are essential if hospitals want to see the success of change.

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Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Cited by 36 publications

References 47 publications

Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes

Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes

Diurnal Variation in Outcomes of Percutaneous Coronary Intervention

Lessons learnt from the implementation of same-day discharge after percutaneous coronary intervention

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