Length of stay following percutaneous coronary intervention: an expert consensus document update from the society for cardiovascular angiography and interventions

January 13, 2020


HEALTH ECONOMICS RELEVANCE

This expert consensus document update clarifies 2009 Consensus Statement of SCAI with the aim of offering contemporary guidance on LOS following PCI across the spectrum of clinical presentations including ACS in response to current data and reflecting current practice, This consensus update: (1) clarifies clinical and reimbursement definitions of discharge strategies, (2) reviews the technological advances and literature supporting reduced hospitalization duration and risk assessment, and (3) describes changes to the consensus recommendations on length of stay following PCI based on advances in vascular access techniques, stent technology, and antiplatelet pharmacology. The new recommendations are particularly relevant given the potential for cost savings. Seto AH, et al. Catheter Cardiovasc Interv. 2018;92(4):717-731. doi: 10.1002/ccd.27637.

KEY RECOMMENDATIONS

The framework for the updated consensus recommendations consider that readiness for discharge should address the “three P’s”: Procedure, Patient, and Program.
Procedure
In most cases a successful PCI is eligible for SDD. Certain high-risk angiographic or procedural situations as shown in the Table should still be considered for overnight observation. Any patient requiring prolonged post-procedure antithrombotic therapy should be considered for overnight observation.
Patient
The patient should be clinically stable, with baseline mental status and vital signs, and have completed the appropriate recovery period for conscious sedation. Baseline conditions such as diabetes, left ventricular dysfunction, and kidney disease should be stable and compensated.
Program
Post-PCI discharge management should take place within the context of a program that encompasses: (1) safe monitoring in the immediate post-PCI period; (2) guideline directed medical therapy including dual antiplatelet therapy and counseling on treatment duration; (3) compliance with PCI performance measures including secondary prevention and education, and (4) timely follow-up, including a phone call within 24–72 hours and a scheduled clinic appointment within 2–4 weeks. In elective patients, ideally 3P can be achieved within 4-6 h post procedure, while in acute setting it takes 2-3 days.

Consensus Recommendations for Discharge Following PCI


HEALTH ECONOMICS IMPLICATIONS

Adopting these new recommendations may help to optimize care of patients undergoing PCI and reduce overall costs associated with the procedure.

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About the Author

JOHN YANUZZELLI
Sr. Strategic Business Manager

Contact: john.yanuzzelli@terumomedical.com

As Strategic Business Account Manager, John assists hospitals in understanding the full financial impact of their care pathway redesign and their ROI. John earned a Master’s Degree in Business from Montclair State University, and has spent over 15 years in the health care fields of cardiology, electrophysiology, orthopedics, and diagnostic imaging. He has worked closely with hospital leadership to develop programs focused on the economic costs of healthcare procedures, including initiating radial adoption, creating reprocessing initiatives and establishing value-based contracts.