2021 ACC Expert Decision Pathway on Same-Day Discharge After PCI

Authors:
Rao SV, Vidovich MI, Gilchrist IC, et al.
Citation:
2021 ACC Expert Consensus Decision Pathway on Same-Day Discharge After Percutaneous Coronary Intervention: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021;Jan 7:[Epub ahead of print].

The following are key points to remember from the 2021 American College of Cardiology (ACC) Expert Consensus Decision Pathway on same-day discharge (SDD) after percutaneous coronary intervention (PCI):

  1. The purpose of this document is to provide a framework (checklist) for considering patients for SDD after elective PCI.
  2. SDD has been shown to be preferred by patients and data support no difference in clinical outcomes between next-day and SDD.
  3. SDD after elective PCI allows for more efficient healthcare by optimizing patient flow and resource utilization.
  4. Studies have shown that SDD after elective PCI is associated with cost savings. In estimation, if 50% of elective PCI patients were discharged on the same day, this would yield a savings of $200 million to $500 million per year in the United States.
  5. SDD is defined as “a stay after a PCI procedure that does not include supervised overnight monitoring in the facility and/or hospital.”
  6. Pre-procedure considerations include clinical factors, social factors, and staff/system factors. Physician input regarding the patient’s clinical candidacy for SDD, in addition to adequate home support for the patient after SDD and the patient being scheduled at an appropriate time for the procedure to allow for SDD later in the day all should be considered prior to PCI.
  7. Post-PCI considerations include a thorough assessment of post-procedural complications, PCI success, absence of any mental status changes, and patient’s willingness to be discharged home.
  8. Prior to discharge, confirming availability of P2Y12 inhibitors and adequate follow-up will be needed.
  9. Patients should be educated on monitoring the access site and be given clear instructions on an emergency number to call.
  10. Checklists provided in this document could be integrated into the electronic medical record and could be used to accurately measure safety and efficacy of SDD.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Angina, Stable, Checklist, Consensus, Cost Savings, Delivery of Health Care, Delivery of Health Care, Integrated, Electronic Health Records, Length of Stay, Organization and Administration, Patient Discharge, Percutaneous Coronary Intervention, Receptors, Purinergic P2Y12, Surgical Procedures, Elective


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