Implementation of an accelerated discharge process following percutaneous coronary intervention for patients with non-ST elevation acute coronary syndromes
| Autor: | Vince Vismara, Deborah Baker, Kurt G Barringhaus, Barry Feldman, Sarah E Slone |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Acute coronary syndrome
medicine.medical_specialty medicine.medical_treatment Patient characteristics 030204 cardiovascular system & hematology 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Patient satisfaction Risk Factors Humans Medicine Knowledge to action 030212 general & internal medicine Acute Coronary Syndrome Advanced and Specialized Nursing business.industry ST elevation Percutaneous coronary intervention medicine.disease Patient Discharge Medical–Surgical Nursing Treatment Outcome Conventional PCI Emergency medicine Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | European Journal of Cardiovascular Nursing. 20:660-666 |
| ISSN: | 1873-1953 1474-5151 |
| DOI: | 10.1093/eurjcn/zvaa029 |
| Popis: | Aims Historically, patients with non-ST elevation acute coronary syndrome (NSTE-ACS) are monitored as inpatients following successful percutaneous coronary intervention (PCI), but accumulating evidence demonstrates that accelerated discharge is safe, reduces cost, and enhances patient satisfaction. This quality improvement project examined the impact of implementing a post-PCI streamlined discharge process for NSTE-ACS patients on length of stay (LOS), major adverse cardiovascular events, and provider utilization at a university-affiliated hospital system. Methods and results Clinical characteristics, the timing of admission, PCI, and discharge data were collected prospectively from patients presenting to the catheterization laboratory for intervention for NSTE-ACS during 90-day historical control and implementation periods. The knowledge to action implementation model was employed to establish a peer-coaching based educational tool for educating interventional cardiologists and inpatient clinicians regarding patients with low-risk characteristics suitable for same-day discharge (SDD) following PCI. Patient characteristics were similar between the historical and implementation periods. Although total hospital LOS did not decrease (51 ± 24 vs. 41 ± 18 h; P = 0.14), the discharge process reduced LOS after PCI among low-risk patients (22 ± 6 vs. 17 ± 8 h; P = 0.003). Complication and readmission rates were unchanged by SDD. Provider utilization of the discharge process increased four-fold during the implementation period (8% vs. 32%; P = 0.02). Conclusions Implementation of an accelerated discharge process following PCI for low-risk NSTE-ACS patients reduced post-PCI LOS without increasing readmissions or complications. Increased utilization of the process throughout the implementation period may be attributed to peer coaching. |
| Databáze: | OpenAIRE |
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