Cardiologists, nurses and patients have developed a same-day discharge pathway for patients undergoing elective PCI, paving the way for shorter hospital stays and a better patient experience while managing risks.

It followed a review of 4,387 patients who had elective PCI in Queensland between 2012 and 2019, showing few were able to return home on the same day as their procedure.

The team found consensus on seven pre-PCI factors, 14 post-PCI factors, a nine-point discharge checklist and five risk management statements. All participants agreed that the cardiologist conducting the procedure had the final say on discharge.

“If the interventional cardiologist feels uncomfortable about sending a patient home on the same day, they have the right to override the clinical pathway by monitoring the patient overnight in the hospital, despite all the criteria are met,” they reported in Heart, Lung & Circulation [link here].

Pre-PCI 

The authors agreed eligibility for same-day discharge should be restricted only to patients aged between 18 and 100 years, who lived within one hour of the closest care centre.

This was more liberal than other pathways in the published literature which put the cut-off age at 75 years, but the reviewers said conducting a frailty test prior to discharge was more important than the numerical age.

Patients must also have a carer at home and must speak English, or have access to an interpreter, and agree to a plan for their same-day discharge before being sent home.

Managing risks after PCI 

According to the pathway, patients wanting same-day discharge must have their procedures prior to 2:00pm between Monday and Friday.

The group agreed patients could be eligible regardless of the access site and number of stents. This could provide more patients with opportunities for same-day release, with previous studies suggesting less than 1% of patients with multi-vessel stents left the day of their procedure.

“The main findings related to risk management are agreeing on the early procedure schedule on the day, providing phone numbers for patients and carers to call, and conducting next-day phone follow-up,” the author said.

Knowing who to call for an emergency consultation was key, meaning patients and their carers must have good phone access to be allowed to depart hospital.

“In our study, one participant (patient) wanted the phone number on a sticky note of an envelope for easy access rather than buried in discharge paperwork, while another participant (carer) described instinctively dialling 000 when complications arise,” the review team said.

Because of this variation, it was decided patients and carers should be told to call 000 if they can’t find the right number for their treating team.

Managing same-day discharge across big distances

While the pathway sets out an evidence-based set of steps for clinicians, implementing same-day discharge in geographically-dispersed systems like Australia remains a challenge.

“Clinicians must assess patients’ suitability for same-day discharge carefully and consider fully their medical conditions and existing support systems before hospital discharge. In addition, clinicians from the PCI centres could collaborate with clinicians in local hospitals (where PCI is not available) to identify their knowledge and skills in managing post-PCI complications and provide support and training if needed,” the authors said.

Telehealth services could also play a role in future, with the research team noting they “could be developed and implemented to ensure patients receive adequate care following [same-day discharge] without restriction of their geographical locations”, they added.