PCI & AimRadial 2018 | Best practices in same day discharge - Ivo Bernat

1. Best practices in same day discharge
Assoc.Prof. Ivo Bernat MD, PhD.
Cardiology Department, University Hospital and Faculty of Medicine Pilsen,
Charles University Prague,
Czech Republic

2. Conflict of interest
• none

3. Same day discharge
• 1994 - 1st published experience from Amsterdam (Br Heart J)
• 2008 - 1st important US data (Am Heart J)
• 2011 - 1st data about older patients in (JAMA)
• 2013 - 1st meta-analysis (JACC CI)
• 2013 - 1st European consensus (Eurointervention)
• 2015 - Last edition of Topol Textbook of Interventional Cardiology
• 2018 - US consensus (CCI) and our Position paper

4. Am Heart J 2008
2008

5. 2013

7. 2013

8. Seto et al. Catheter Cardiovasc Interv 2018
2018

9. YES NO

10. CCI 2018

11. SDD position paper 2018
of the Czech Interventional Cardiology Associaltion
Cor et Vasa 2018;60: 236-239

12. Dedicated Lounge is better than beds …

13. 150 m2
50 m2
50 m2

14. Our radial lounge for 800 patients (= half of our elective pts)
Four chairs
Nurse´s and kitchen corner
TV, internet
Table for lunch and RBT

15. Radial artery patency control by RBT in our Lounge

16. What we do and require ?
Before admission :
• Instructions - one page for the patient
• History - one page from his physician incl. echo and lab. results
• Admission - first two pts at 7 a.m., 3rd and 4th at 8.a.m. (CAG and PCI between 9 a.m.-noon)
In the Lounge:
• Routine postprocedural care - minimal compression pressure á 20 min, compression time,
hematoma measurement, final RBT, 1 hour ulnar compression in case of RAO
• Lunch at noon
• Fluid intake control - 1500 ml before discharge
• Patient satisfaction control by questionaire
• Signatures before discharge about complete informations
• After discharge:
• Discharge and overnight stay only with family member or close person
• In case of overnight complications - immediate phone contact to ICU
• We do not contact patient next day personally

17. Instructions
before admission
a) for physicians
b) for patients

18. Nurse´s document in Lounge
in red :
1.date
2. type of procedure
3. start of compression (time)
4. 0 ml in TR Band (time)
5. total compression time (minutes)

19. Last trials from our Lounge
•
n=280
. RAO detected by RBT and duplex ultrasound - RAO …. 0,4%
n=500 (will be published in 2019)
RAO 0 %, compresion time 60 vs 90 min
(Cor et Vasa 2018)

20. Nurse in our Lounge
1. arranges admission, documents and basic examination of the patient
2. arranges transfer to and from the cathlab
3. arranges optimal postprocedural radial artery care including patent
hemostasis and short total compression time, measures hematomas , HR, BP…
4. arranges lunch and fluid intake (1,5 liter during the stay in the Lounge)
5. arranges discharge including personal contact with family member, finalizes
documents

21. Lounge in University Hospital Pilsen
• number of patients PCI pacemaker exchange
• 2009 301 72 0
• 2010 706 179 36
• 2011 708 155 76
• 2012 748 161 89
• 2013 821 177 105
• 2014 853 162 108
• 2015 825 184 94
• 2016 817 179 100
• 2017 773 165 76
• 2018 700 150 50
--------------------------------------------------------------------------------
Total: ˃ 7000 pts ˃ 1500 PCI ˃ 700 pacemaker exchanges

22. Conclusion
Optimal conditions for outpatient coronary angiography and PCI in 2018 :
• Transradial approach in experienced radial center
• Dedicated infrastructure - Lounge
• Careful patients selection
• Adequate information before and after PCI
• Dedicated and trained nursing and medical staff
Then SDD is definitely recommended for majority of selective stable patients