Authors (including presenting author) :
Chan CMC, Lee MKY, Wong ECY, Chan AKC, Chui SF, Tsang SCF, Ng SY, Lam CB, Wong HHY, Chung YM, Chiu SKM, Lam WK, Hui ML
Affiliation :
Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital
Introduction :
Since December 2019, COVID-19 spread rapidly across countries.1 Every effort has been paid to contain the outbreak and prevent the healthcare system from being overwhelmed. The Hospital Authority of Hong Kong, has escalated the alert system to the Emergency Response Level since January 2020. Some non-urgent clinical patient services were suspended or reduced accordingly, including elective percutaneous coronary intervention (PCI). However, the service needs of patients with coronary artery disease cannot be neglected, particularly those scheduled for PCI, who have persistent ischaemic symptoms.
Historically, overnight observation to monitor periprocedural complications is the standard of care after PCI and the main stream of practice in Hong Kong. With the advancement in technology, numerous observational and randomized controlled trials have been conducted to evaluate the safety of same day discharge (SDD) after PCI for low-risk patients. Two meta-analyses published in 2013 had cons
Objectives :
To report the experience of implementing SDD after elective PCI during the outbreak of COVID-19 in a single center with well-structured Ambulatory Cardiac Center of QEH in Hong Kong.
Methodology :
A retrospective cohort study of patients underwent elective PCI from January to July in 2019 and 2020 was conducted to examine the safety of SDD. A comparative analysis was performed to identify the differences between SDD patients and overnight patients in terms of baseline, clinical and procedural related factors. Logistic regression was conducted to identify the factors that predict SDD or overnight stay after the procedures.
Result & Outcome :
680 patients underwent elective PCI, which included 376 in 2019 and 304 in 2020. The mean length of stay was 1.58 (SD ± 1.60) and the total length of stay was 908 days for the overnight patients in both years. The number of SDD patients had a significant increase from 2019 to 2020 (10.1% vs. 22.4%, p< 0.001). There were no significant differences in the number of complications occurred during the index admission between the SDD and overnight patients. The SDD patients had significantly lower 30-day readmission than the overnight patients (0% vs. 8.9%, p< 0.001). There was no significant difference in 30-day mortality.
Multivariate analysis indicated that using radial approach as vascular access (p < .001) was more likely to be discharged on the same day, while those receiving IVUS (p = 0.001) and PCI (p < 0.001) procedures, with longer procedural time (p < 0.001) and having the history of dyslipidemia (p = 0.002) were more likely to stay overnight after the elective procedures.
The outbreak of COVID-19 offered a golden opportunity to implement SDD for uncomplicated elective PCI in our center. This evidence-based protocol-driven SDD strategy, implemented by the competent nurses with medical support by Cardiologists, was well-accepted by our patients., It not only reduces the chance of nosocomial infections during the pandemic but also cost-saving for the hospital. The development of SDD protocol and checklist as a tool that addresses multiple facets of the patient care pathway. This initial successful experience helps to further advocate SDD for selected elective PCI and sets new perspectives on the new model of care delivery
