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Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory in Belgium: Value Based
Eric Wyffels1, Monika Beles1, Ann Baeyens1
1Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
Insights
Same day discharge (SDD) after cardiac catheterization reduces societal costs and maintains patient satisfaction and clinical outcomes. However, this strategy significantly decreases hospital and physician revenues, impacting its long-term viability.
Area of Science:
- Cardiology
- Health Economics
- Healthcare Management
Background:
- Cardiac catheterization is a common procedure with associated hospitalization costs.
- Optimizing patient discharge strategies can impact healthcare economics and patient experience.
Purpose of the Study:
- To evaluate the impact of a default same-day discharge (SDD) strategy on patient outcomes and hospital revenues for cardiac catheterization procedures.
- To assess the societal cost implications of implementing SDD.
Main Methods:
- A retrospective analysis of cardiac catheterization patients in 2019 and 2021 in a Belgian hospital.
- Prospective collection of patient-reported outcomes, satisfaction, and financial data for the SDD cohort in 2021.
- Comparison of clinical outcomes (all-cause death, readmission rates) and financial data between cohorts.
Main Results:
- The proportion of patients undergoing SDD increased from 28% to 44%, saving 889 hospitalizations.
- All-cause death (0.17% vs 0.15%) and readmission rates (0.7% vs 1.8%) remained unchanged.
- Patient satisfaction was high (91% top box score), Net Promoter Score was 89.5, and in-hospital spending decreased by €3206 per procedure (57% revenue reduction).
Conclusions:
- A default SDD strategy for cardiac catheterization improves societal cost-effectiveness and patient satisfaction without compromising clinical outcomes.
- The significant reduction in hospital and physician revenue poses a challenge to the sustainability of this SDD protocol in the studied context.
Aims:
To assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital.
Methods And Results:
Outcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021. The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income.
Conclusion:
Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.
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