5/24/2012 - Vanderbilt Heart & Vascular Institute has implemented a new protocol that allows same-day discharge for uncomplicated stent procedures.
Maj. George Carlson, 53, from Ft. Campbell, Ky., arrived at Vanderbilt the morning of May 1, had a stent placed in his left anterior descending artery to open up a blockage, and went home that evening. He was the first patient to benefit from this new program, said his cardiologist, Mark Glazer, M.D.
“In the past, we monitored patients overnight and let them go home the next day,” Glazer said. “We realized that those patients at low risk for complications could safely be discharged home the same day, freeing up a bed for our sicker patients.”
Carlson was a regular runner who began to experience chest pain about two miles into his run. A stress test revealed anterior ischemia, or reduced blood flow to the front of his heart. He needed just one stent, which could be sent up to his heart via the radial artery in his wrist. He was the ideal candidate for the same day protocol, said Elias Haddad, M.D., who, with Danielle Ruzic, R.N., developed the protocol.
“Doing more stent placements through the radial artery, as opposed to the femoral artery in the leg, means less risk of vascular complications and bleeding complications. That definitely plays into this,” Haddad said. “Most straightforward stent cases do very well, but we have routinely admitted them to the hospital for observation. It’s just the way it’s always been done.”
Many medical centers are moving to same-day discharge for straightforward stent procedures, also known as percutaneous coronary intervention (PCI).
“We are always looking for better ways to care for our patients. We were among the first in the region to offer radial artery catheterization, and now we are focusing on the same-day PCI program,” said David Zhao, M.D., director of the Cardiac Catheterization Laboratory. “We believe that this will provide more convenience to our patients yet maintain high quality care.”
VHVI has set strict criteria that patients have to meet for same-day discharge. These include the distance the patient lives from the hospital, good family support at home and lack of clinical risk factors for bad outcomes. Additionally, the patient must be mobile and able to walk a certain distance after the procedure.
"The patients love it. Once you tell the patients they can go home and sleep in their own bed, they are for it,” Haddad said. “It takes time for physicians who have been doing cardiac interventions for a long time to get comfortable sending patients home the same day.”
Haddad expects that 5 percent to 10 percent of stent cases will qualify for same-day discharge in the first six months to a year of the program.
“I received really great care, so if I had to stay the night in the hospital that would not have been bad at all,” Carlson said. “I would be more comfortable at home, and if there was someone who needed medical care more than I did, they could turn their attention to them.”