Decision pathway provides checklist of factors to consider before same-day discharge after nonurgent PCI

The American College of Cardiology's expert consensus decision pathway includes a checklist of clinical, social, and facility/systems factors to consider before and after elective percutaneous coronary intervention (PCI) to help clinicians make informed decisions around same-day discharge.

A new decision pathway from the American College of Cardiology aims to help clinicians make decisions around same-day discharge after percutaneous coronary intervention (PCI).

The expert consensus decision pathway, published online on Jan. 7 by the Journal of the American College of Cardiology, provides clinicians with a checklist of clinical, social, and facility/systems factors that indicate whether a patient can be safely considered for same-day discharge. It is applicable to patients presenting for an elective PCI but is not applicable to patients presenting with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction.

The checklist for consideration of same-day discharge after PCI includes the following:

  • Pre-PCI considerations include the physician's input about whether the patient is a candidate for same-day discharge, as well as three social factors: whether the patient or caregiver can call 911, whether a caregiver is available if needed, and whether the patient is willing to go home. In addition, a staff/systems factor to consider is having the scheduler inform the patient about the possibility of same-day discharge and schedule the PCI early enough in the day to allow for reasonable observation before same-day discharge.
  • Post-PCI considerations include whether the patient is willing to go home, as well as the following clinical factors: perioperative complications, success of PCI, exacerbation of disease, and change in mental status from baseline.
  • A predischarge checklist includes the following: administration of P2Y12 inhibitor loading dose, patient receipt of prescriptions for P2Y12 inhibitor for at least 30 days, prescription for aspirin and statin, referral to cardiac rehab, follow-up call with the patient on the day after discharge, and follow-up appointment. In addition, the catheterization laboratory/postprocedural staff should provide education to the patient on monitoring the access site and the emergency number to call, the pathway said.

“PCI has evolved in safety and efficacy such that many patients can leave facilities the same day as the procedure, with retrospective data showing no increase in death or rehospitalization compared with patients who stay for overnight monitoring. … Implementing this checklist, and thus likely widening the pool of patients who can be identified as candidates for safe [same-day discharge], will lead to greater patient satisfaction and awareness as well as increased savings within facilities,” the authors of the pathway wrote.