SCAI: Following guidelines increases same-day PCI discharges

Implementing standards on length of stay after PCI procedures reduced the percentage of patients kept overnight by more than half, authors of a poster reported May 9 at the Society of Cardiovascular Angiography and Interventions (SCAI) scientific sessions in Orlando, Fla.

In 2009, SCAI published an expert consensus statement on length of stay after PCIs that included a decision matrix to help interventional cardiologists and hospitals determine timing of discharge in cases that were elective and uncomplicated. D. Scott Gant, DO, chief of the interventional cardiology section at Scott and White Healthcare in Temple, Texas, and colleagues noted that their quality improvement committee adopted the practice guidelines as a way to reduce variation in care and improve outcomes.

To evaluate the effect of the initiative on discharge patterns, they reviewed 521 outpatient coronary interventions at their institution between January 2010 and November 2012. In that period, 284 patients remained under observation overnight and 237 were discharged the same day. In 2010, 81 percent of patients were hospitalized overnight; in 2011 and 2012, 39 percent remained for overnight observation after PCI.

Of the overnight PCI cases in 2012, 75 percent were observed due to procedural complications or patient comorbidities, in keeping with the practice guidelines. Timing and resources played a role in 14 percent of cases, with completion of PCI procedures occurring too late for timely discharge. Eight percent of cases had access site complications and 3 percent were held at the discretion of the cardiologist.