Novel Patient-Centered Approach to Facilitate Same-Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

J Am Heart Assoc. 2018 Feb 15;7(4):e005733. doi: 10.1161/JAHA.117.005733.


Background: Same-day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low-risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a "patient-centered" protocol based on risk of complications at Barnes-Jewish Hospital.

Methods and results: Our objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient-centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient-centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes-Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score-adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient-centered approach markedly increased SDD eligibility.

Conclusions: With a patient-centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient-centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

Keywords: cost; elective percutaneous coronary intervention; hospital costs; percutaneous coronary intervention; same‐day discharge; transradial; transradial approach.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Kidney Injury / etiology
  • Aged
  • Clinical Decision-Making
  • Coronary Angiography
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / economics
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Cost Savings
  • Cost-Benefit Analysis
  • Female
  • Hemorrhage / etiology
  • Hospital Costs
  • Humans
  • Length of Stay / economics
  • Length of Stay / trends*
  • Male
  • Middle Aged
  • Missouri
  • Patient Discharge / economics
  • Patient Discharge / trends*
  • Patient Satisfaction
  • Patient Selection
  • Patient-Centered Care / economics
  • Patient-Centered Care / trends*
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / economics
  • Percutaneous Coronary Intervention / mortality
  • Percutaneous Coronary Intervention / trends*
  • Registries
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome