To help hospitals transition to more same-day discharge after elective percutaneous coronary intervention (PCI), the American College of Cardiology (ACC) released a checklist on deciding whether an overnight stay is necessary.
Among those factors, it noted, same-day discharge programs must make sure of the safety of the patient by considering:
- Availability of a caregiver if needed
- Complications during PCI
- Change in mental status from baseline
- Plans made for prescription of antithrombotic medications, referral to cardiac rehab
- Patient education on how to monitor the catheter access site
The ACC expert consensus decision pathway detailing the checklist was published online in the Journal of the American College of Cardiology. Individual centers may tailor the tool according to their workflow and resources, authors said.
“We’re hoping that this does increase the number of centers with same-day discharge [SDD] programs. We basically ‘crowdsourced’ as many SDD protocols as we could to find common themes among them to fashion the pathway,” writing group chair Sunil Rao MD, of Duke University Medical Center in Durham, North Carolina, told MedPage Today.
He said that his group hopes that the guideline document will ultimately result in more elective PCI patients going home the day of their procedure. The rationale for this practice includes patient preference (e.g., returning to the comfort of one’s home) and safety (e.g., avoiding hospital-acquired infection), as well as savings and improved bed capacity for hospitals.
Same-day discharge likely remains underutilized in the U.S., with an estimated 3.5% of people headed home the day of their PCI in 2006-2015.
“Ideally, patients suitable for SDD should be identified prior to the procedure and be informed as early as possible of the goal for SDD. This advance notice may help identify unforeseen barriers to SDD and provide an opportunity to address patients’ and caregivers’ expectations and concerns,” Rao’s group wrote.
The ACC group did acknowledge some lingering uncertainty around same-day discharge: The evidence base supporting this practice is largely observational, the writers noted, with just a few small randomized trials completed. However, there appears to be no increase in death, rehospitalization, or other complications.
Authors also cautioned that the guidance on same-day discharge applies only to adults undergoing elective PCI. Patients with ST-elevation MI or non-ST-elevation MI should be hospitalized at least for one night following PCI for postprocedural monitoring.
Rao had no disclosures.