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Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs

Cheryl Clark, for HealthLeaders Media, October 5, 2011

Under their proposed model, "If an elective patient has a successful PCI procedure, didn't require prolonged intravenous medications, perhaps has the procedure radially (through the wrist rather than through the groin)...has someone to go home to, has all their medications and is educated on what to look for, that's an ideal candidate who can go home that day," he said.

He does not, however, advise discharging patients after 7 p.m.

Ralph G. Brindis, MD, a co-author and the immediate past president of the American College of Cardiology, added that recent improvements in revascularization procedures have made them much safer.

"In the early days of angioplasty, some 3 to 4% of patients who received coronary stents needed emergency bypass, but that's clearly no longer the case," Brindis said in a telephone interview. "That's now down to .1%"

Additionally, older anticoagulation medicine regimens put patients at higher risk of bleeding, catheter sizes were much larger than those in use today, and closure devices were much less sophisticated.

Brindis added that PCI is increasingly performed through the wrist, through procedure developed in part by Rao, which also reduces risk of bleeding. "As recently as a year and a half ago, 3% were done through the wrist, but in recent months that rate has risen to 10-15%."

Lastly, he predicted that patient experience scores will likely go up for patients who don't have to spend the night in a hospital.

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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