Implementation and Evaluation of a Same-Day Discharge Protocol for Percutaneous Coronary Intervention
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Kinney, Margaret E.
Purpose: The purpose of this Doctor of Nursing Practice (DNP) project focuses on the development, implementation, and evaluation of a protocol for same-day discharge (SDD) for percutaneous coronary intervention (PCI).|Background: Cardiovascular disease is the leading cause of death in the United States. Health care providers are challenged to lower the cost of care while improving outcomes. Same-day discharge for elective percutaneous coronary intervention is utilized to lower the cost of cardiac care and improve quality of life for patients.|Sample/Setting: The project involved patients at Methodist Jennie Edmundson Hospital in Council Bluffs, Iowa who met the evidence-based criteria for the same-day discharge for PCI.|Methods: The project was approved as a quality improvement project by Methodist Jennie Edmundson Hospital and the Institutional Review Board at Creighton University. Preoperative, intraoperative and postoperative criteria were utilized to determine patient's eligibility for same-day discharge. After a same-day discharge was ordered, data collection was able to begin. There were three aims to be studied in patients eligible for same-day discharge. First, the necessity of the procedure was considered using appropriate use criteria (AUC). Secondly, following the intervention, patients were monitored for complications for 30 days. Finally, patients' referral and attendance at cardiac rehabilitation was monitored.|Results: Three patients completed the same-day discharge process during the study period from September 21, 2018 through December 31, 2018. Two of the patients had appropriate procedures based on the AUC. There were no complications at 30-days postoperatively. All patients enrolled in outpatient cardiac rehabilitation within one week of discharge and continue to participate in cardiac rehabilitation.|Conclusion: There was successful implementation of same-day discharge protocol for percutaneous intervention. There were clinical and social barriers identified during the implementation process. These must be overcome to increase the volume of patients completing the same-day discharge process.
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