ACCA: Same-day discharge possible post-PCI

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CHICAGO—Attempting to get patients in an out of the hospital quicker after PCI is feasible and should be a goal for hospitals, especially for those looking for an avenue to cut costs, said L. Van-Thomas Crisco, MD, medical group of St. Joseph’s—Cardiology in Atlanta, during a presentation March 23 at the American College of Cardiovascular Administrators (ACCA) annual meeting.

With advances in radial PCI, a quicker discharge post-PCI is now more possible. At St. Joseph’s, the aim is to get patients discharged within four hours of a PCI procedure, he said.

But how can providers get hospital administrators on board?

Crisco said that providers must sit down with the hospital's chief financial officer and convince him or her that sending the patient home frees up the bed for a different use. “This is a utilization opportunity,” he said. “These are not easy numbers to get a hold of, but if you make the right case, you can get the program started.”

Crisco noted the EASY trial from Canada compared the average per patient cost within 30 days post-PCI with the difference in costs 30 days post-procedure by sending a patient home early. The savings were about $1,141 (Canadian dollars).

“If you can convince anyone at your hospital that you have the potential to save $1,000 dollars by sending a patient home with early PCI, they will be interested,” Crisco offered. He estimated that the cost-benefit of same-day discharge for PCI patients could be between $750 and $1,108.

To get to same-day discharge PCI faster, some have looked toward the transradial approach. “There are no radial access-related deaths. Period,” Crisco offered. “Additionally, there are very few vascular complications.”

However, while the transradial approach can shorten length of stay and increase patient satisfaction, he said that it is important to perform proper patient selection.

“Decisions about same-day PCI discharge should be based on procedural outcomes, rather than preprocedural characteristics,” Crisco noted.

Additionally, he said that there may be many barriers to this utilization including:

  • Medico-legal;
  • Hospital resource allocation;
  • Absence of economic incentive; and
  • Attempting to get physicians to change practice patterns.

Crisco also offered to get a same-day discharge program going:

  • Choose a physician champion;
  • Put a team in place (interventional cardiologists, nurses, pharmacy, clinical care coordinator, cath lab team, administrators and mid-level care providers);
  • Incentivize the program;
  • Perform radial access (not mandatory but helpful);
  • Have a dedicated space.

St. Joseph’s incorporated a radial lounge into the process, which is equipped with a coffee bar, wifi, comfortable chairs and entertainment.  

The key, he said, to getting a patient out four hours post-PCI is ensuring that you have “amenable, responsible, appropriate patients with supportive caregivers.” Patients must have access back to the hospital if needed and  must be able to get in touch with the hospital within 48 hours to provide information on their progress.

“Hospitals are high-risk places for low-risk patients,” Crisco said. “Change the access, change the culture, and then change the discharge destination.”