Radial catheterizations led doctors to a Same Day Discharge strategy helping them maximize cost savings and help improve clinical outcomes
October 30, 2020
Since our hospital system transition to a near 100% adoption of radial access for cardiac catheterization, we have naturally moved to same day discharge for the management of our post PCI patients. The impact of this changed paradigm has come with an extension to the other hospital systems in our city where if a heart catheterization is done in Albuquerque the patient has a 90% chance that it is done through the wrist. Each institution that has moved to radial catheterization has also adopted a same day discharge PCI strategy. The impact of same day discharge in a rural community with significant centralization of care has had the greatest impact in simply freeing up beds for referrals. There is a significant financial and clinical benefit with radial catheterization and with the same day discharge process, however the overall patient flow out of the hospital rather than occupying an inpatient bed has had the most substantial impact for the system. This allows us to bring in patients who are critically ill without delay. It allows for movement of patients out of the ICU in a more expeditious fashion to floor beds. And it allows the entire system to simply operate more efficiently with higher volumes. The impact of these system changes are hard to measure through a system that cares for high volume of patients. We do know that our inpatient length of stay with cardiovascular diagnosis has been impacted by the patient flow in the outpatient setting as transfers are able to arrive more quickly and the inpatients are able then to move through the system more effectively. There has been no appreciable increase in complications with widespread utilization of the same day discharge program either. Our protocol has been widely utilized throughout our system, and it allows even high risk patients such as post atherectomy or multivessel intervention patients early ambulation and discharge. The most amazing thing about the same day discharge protocol though is how it has been normalized where it is what patient’s expect in the community.
About the Author
MARK C. BIENIARZ, MD, FACC, FSCAI
Interventional Cardiology and Structural Heart Disease
New Mexico Heart Institute
Medical Director, Cardiovascular Service Line
Lovelace Health System
Mark is the chief of cardiovascular services with the New Mexico Heart Institute. Dr. Bieniarz’ clinical interests include: acute coronary and peripheral vascular angioplasty and stents, emergent cardiac and vascular care, and diagnosis and treatment of chronic cardiac and vascular conditions. Dr. Bieniarz is a veteran of Operation Enduring Freedom in Afghanistan where he served as a flight surgeon and attained the rank of Captain. He was nominated for Flight Surgeon of the Year. Dr. Bieniarz practices at the major health centers in Albuquerque, including the Heart Hospital of New Mexico, Presbyterian Hospital, and Lovelace Medical Center. Dr. Bieniarz sees patients by appointment at New Mexico Heart Institute’s comprehensive cardiovascular care centers in Albuquerque and Rio Rancho.