Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol

Abstract

Background and aims Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, we implemented a streamlined, nurse-coordinated SDD program following a standardized protocol. Methods As dedicated SDD coordinator a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient-flow, in-hospital logistics, patient education and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were eligible if LVEF ≥35%, basic support at home and accessibility of the hospital within 60min were warranted. Results 420 consecutive patients were screened by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%) or LVEF <35% (17, 4.0%). Of the eligible patients 300 (91%) were successfully discharged the same day. There was no major post-SDD complication. Rates of unplanned medical attention (19, 6.3%) and 30d-readmission (5, 1.6%) were extremely low and driven by femoral access site complications. Those were significantly reduced upon introduction of compulsory ultrasound-guided puncture after the initial 150 SDD patients (p=0.0145). Standardized SDD-coordination resulted in efficient workflows and reduced the total workload of the medical staff. Conclusions SDD after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the forthcoming transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.