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.