Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs
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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