With an increasing shift towards same-day discharge (SDD) as a means of improving access for an increasing number of patients undergoing intracardiac catheter ablation, a new Scientific Statement from the Heart Rhythm Society (HRS) and the ACC offers guiding principles and best practices for effective SDD strategies based on the latest global clinical data and real-world evidence.

The statement, chaired by Amit J. Shanker, MD, FACC, and Samuel O. Jones IV, MD, MPH, FACC, and published in JACC: Clinical Electrophysiology, highlights recent data underscoring the benefits of cardiac ablation SDD strategies on patient safety and access, as well as advances in technology that are helping to improve procedural efficiencies and reduce the length of hospitalization and mitigate costs.

"The field of electrophysiology continues to evolve due to improved workflows, technological innovations, and procedural advancements," said Jones. "Fueled by the COVID-19 pandemic, many centers adopted same-day discharge protocols, which have continued to be refined. A growing body of literature supports this paradigm for patients, appropriately selected by the electrophysiologist, as safe and effective as well as patient-centered, while also freeing up necessary resources in the health care facility."

Among the recommendations when considering an SDD strategy, the statement urges a shared decision-making approach between the clinician and patient that takes into account patient safety, comfort and procedural outcomes. It also recommends that any SDD protocol carefully consider baseline patients factors for preprocedural screening, procedural planning and postprocedure management.

Additionally, the statement stresses the need for "well-considered plans" that anticipate complications, potential transfer to inpatient facilities if at an ambulatory surgery center (ASC), and other logistical issues and that "intentionally support close coordination of care with patients and their caregivers."

Looking ahead, the statement supports the use of clinical registries and quality measures to track real-world outcomes and continue to inform and evolve future SDD best practices and strategies.

"Access challenges (exacerbated during the COVID-19 public health emergency) and economic pressures have driven a shift in practice trends to reduce hospitalization duration and optimize resource utilization," write Shanker, Jones and colleagues. "This has necessitated an evolution in clinical flow paradigms to include alternate sites of care (i.e., ASCs and office-based laboratories). To that end, an SDD strategy could result in significant operational efficiencies at the hospital/facility level, improvement in patient access, improvement in the patient's perceived benefit, and result in reduction in overall health care expenditures and resource utilization."