Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs

Cheryl Clark, for HealthLeaders Media , October 5, 2011

Hospitals could dramatically improve patient flow and save money by discharging low-risk elective percutaneous coronary intervention patients 12 hours earlier rather than keeping them through the night, according to a report in the Journal of the American Medical Association.

The researchers, led by Sunil V. Rao, MD, of Duke Clinical Research Institute in Durham, NC, examined an American College of Cardiology database of 107,018 Medicare patients who were kept up to 23 hours after their PCI procedures. The population was separated into five groups based on their risk of complications and rehospitalizations.

They discovered that earlier, or "same-day" discharge, say after a five- or six- hour recovery from the procedure, is safe for the lowest risk group of patients. Unfortunately, hospitals' current practice is to send home on the same day fewer than 2% of the patients who fit in this category.

The researchers estimated that some 20% of patients who are now kept overnight, but discharged within 24 hours, can safely be discharged much earlier, Rao said, freeing up bed space and labor resources for other, sicker patients.

"The bottom line is that PCI has evolved to the point where it's a very efficacious and safe procedure, and same-day discharge for elective PCI patients is an efficient care strategy that may fit into the protocols of major medical centers that are thinking about increasing efficiency," Rao said in a telephone interview.

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2 comments on "Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs"

Dr. Simon Lo (10/7/2011 at 10:21 AM)
Very good news. I have been doing day-case PCI since 2002. Finally there is good evidence to support my procedure

Kenneth R Rubin MD MA MHCM FACEP (10/6/2011 at 2:39 PM)
Interestingly, this study reaches the same conclusion as do many previous such studies, that among a [INVALID]ED group of low-risk patients undergoing elective PCI, sameday discharge is safe. In this study, 84% of all patients needing PCI were eliminated from the study cohort on clinical grounds, while only 1.25% of patients were actually discharged on the same day as their PCI. Both Milliman Care Guidelines and the healthcare payer community have conveniently and dangerously generalized 1.25% to mean all patients needing PCI. The vast majority of studies in the evidence-based medical literature, exclude significant percentages of patients from the outpatient PCI study cohorts for safety reasons. Yet, Milliman Care Guidelines and the payer community claim that outpatient PCI is the standard of care for EVERY patient. What we are witnessing is the nearly universal misinterpretation of the evidence-based medical literature, for financial gain of the payer community, at the expense of hospitals, who provide the necessary inpatient level of care for most patients. This study, by Rao et al, in its context statement, says: "Patients undergoing elective percutaneous coronary intervention (PCI) are generally observed overnight in the hospital." Most hospitals do keep patients overnight, not observing, but providing an inpatient level of care, including room-and-board costs, for the sake of patient safety. Hospitals should be correctly reimbursed for the inpatient level of care, the only prudent and safe manner in which to manage elective PCI in 88.5% of cases. The evidence-based medical literature, such as the present study by Rao et al[INVALID]despite being twisted, perverted, and misinterpreted by the payer community[INVALID]clearly shows outpatient PCI to be UNSAFE for the vast majority of patients. Do not allow the payers to make a travesty of the evidence-based medical literature. Kenneth R. Rubin, MD, MA, MHCM, FACEP Physician Advisor, St. Francis Hospital-The Heart Center




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