Abstract 15514: Same Day Discharge vs Overnight Stay After Transradial PCI Results in Equivalent Safety with Significant Cost Savings/Increased Margin for the Hospital
Traditionally, PCI patients are kept in the hospital overnight to monitor for possible complications. As the process of PCI has improved and cardiac complications have dropped significantly, the justification for an overnight stay has mainly shifted to the need to monitor for access site complications. Since access site complications are reduced dramatically when PCI is performed via the radial artery compared to the femoral artery, selected transradial PCI patients can be discharged the same day as their PCI. Concerns have been raised that a practice of discharging PCI patients on the same day would be financially deleterious to the hospital since bundled payments include reimbursements for charges accumulated during an overnight stay. To study the safety of same day transradial PCI as well as the financial impact to the hospital, we performed a 13 patient clinical initiative in which patients were discharged 4-6 hours after PCI. The age range was from 46 to 83 years of age, 10 of the 13 patients were men, all PCIs were elective and deemed low to moderate risk (no LM disease, LVEF>45%, normal renal function, single or double vessel CAD). All patients were checked by the attending interventionalist 4-6 hours after the procedure to see if discharge was appropriate and all patients returned to the hospital the next day for a brief, no-charge follow up visit. There were no cardiac or access site complications. Data regarding hospital charges, costs, and margins for these 13 same day discharge patients were compared to those for 1200 consecutive patients treated with elective PCI who had an overnight stay. We compared average, per patient financial parameters between the two groups. Comparing the same day discharge patients to the overnight stay patients: total charges were lower ($42,006 vs $48,177), deductions from revenue or "write offs" were lower ($27,306 vs $36,635), net revenue was higher ($14,700 vs $11,542) and the hospital's contribution margin (net revenue minus direct costs) was higher ($9,290 vs $4,438). This pilot program confirms the safety of same day discharge of selected transradial PCI patients and suggests that it may have a positive financial impact for the hospital.
- © 2012 by American Heart Association, Inc.