Same-day discharge after PCI? American College of Cardiology shares a new guidance

Same-day discharge (SDD) after percutaneous coronary intervention (PCI) can provide value to both patients and healthcare providers. However, knowing when SDD is the right choice—and when it isn’t—can be especially challenging.

A new guidance from the American College of Cardiology, published in the Journal of the American College of Cardiology, was designed to help cardiologists and their teams make the best decisions possible when it comes to SDD after PCI. The document details key factors that need to be considered before and after the procedure, examines various pre-discharge processes and even covers the appropriate schedule for outpatient follow-up examinations.

“PCI has evolved in safety and efficacy such that many patients can leave facilities the same day as the procedure, with retrospective data showing no increase in death or rehospitalization compared with patients who stay for overnight monitoring,” according to the document. “In addition, SDD is preferred by patients and can increase savings and bed capacity. However, uncertainty around SDD for PCI remains. This expert consensus decision pathway has aimed to address this uncertainty.”

A key part of the writing group’s effort is the checklist that can help determine if SDD should be considered. If the patient presented with STEMI or NSTEMI, for instance, the checklist tells providers they should monitor that individual overnight. If the patient does not have adequate caregiver support—or there’s a caregiver, but they can’t reach 911 if necessary—the checklist also indicates that overnight monitoring is necessary.

Sometimes, of course, there just won’t be enough time in the day for SDD to be a valid option. If the procedure ends late in the day, not leaving enough time for four to six hours of post-PCI observation, the checklist also tells providers to monitor the patient overnight.

There are technically three smaller checklists that make up the larger checklist—a pre-procedure list, a post-procedure list and a pre-discharge list. They were designed to be used together when making decisions related to SDD.

“It is the belief of the writing group that implementing this checklist, and thus likely widening the pool of patients who can be identified as candidates for safe SDD, will lead to greater patient satisfaction and awareness as well as increased savings within facilities,” according to the document. “Implementation of this checklist also provides institutions with an opportunity to carry out quality evaluations as data from the checklist can be used to inform the evolution of future checklists and protocols in SDD for PCI.”

Read the full document here.