Same-day discharge of patients getting stent 'saves' 100 bed days: PGI study

Naina Mishra

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Chandigarh, November 20

A PGI study has suggested by discharging heart patients who have undergone percutaneous coronary intervention (stent in coronary artery) the same day can save 100 cardiac unit bed days (when patient is confined to a bed and stays overnight in hospital) for those with heart conditions, thereby increasing their turnover and reducing waiting time.

The study evaluated the safety and feasibility of same-day discharge (SDD) after percutaneous coronary intervention (PCI) at a tertiary care public centre and compared the economic impact of the SDD versus next-day discharge (NDD).

Of the total 675 PCI patients, 617 were enrolled in the study, and 21.39% patients were discharged the same day. As many as 65% of the patients in the SDD cohort presented with acute coronary syndrome against 70% in the NDD cohort.

The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, the PGI doctors computed the total societal expenditure of each PCI, which includes both the health system costs and the expenditure borne by the patients.

In the SDD group, the study found there were no readmissions or adverse events after discharge till six weeks of follow-up. The total mean cost of the PCI for the SDD and NDD was Rs 1,29,322 and Rs 1,65,500, respectively.

An amount of Rs 36,178 was saved for each SDD. Besides 100 cardiac unit bed days, including 85 intensive cardiac care bed days, were saved with 21% SDD in the present cohort.

“Post PCI, SDD is safe and feasible in selected ACS/chronic stable angina patients using the ‘patient-centred’ approach. Besides, decreasing out of pocket expenditure for the patients, the SDD also helps in efficient use of scarce health system resources,” it says.

The study shows the SDD in the group was safe and feasible, irrespective of co-morbidities. The SDD helps in efficient use of scarce health care resources and also improves the value, it adds.

PGI study findings

• Of 617 patients enrolled in study, 21.39% discharged same day, rest next day
• In same-day discharge group, no readmissions/adverse events found till 6 weeks of follow-up
• Among 100 cardiac unit bed days saved, 85 were intensive care bed days