Advanced practice nurse-coordinated same-day-discharge after atrial fibrillation ablation

Abstract

Abstract Background Catheter ablation is an effective atrial fibrillation (AF) therapy, but a complex, resource-intensive procedure. Same-day discharge (SDD) reduces utilization of health care resources including personell and hospital beds, and may help to accommodate the increasing demand for AF ablation. However, besides structural adaptations, SDD requires more efficient logistics and coordination. Purpose Against this background, we established and validated a streamlined SDD program fully coordinated by an advanced practice nurse. Methods As dedicated SDD coordinator the advanced practice nurse was in charge of the full SDD protocol, including patient eligibility, patient flow, in-hospital logistics, patient education, discharge and short-term follow-up. For inclusion, basic home support and accessibility of the hospital within 60 minutes had to be warranted. Patients with LVEF <35% were excluded. Ablation was performed at the operator’s discretion. Ultrasound-guided femoral puncture was at the operator’s discretion for the first 150 SDD patients but became mandatory per protocol for all subsequent patients. Discharge by the SDD coordinator followed a standardized protocol including supervised ambulation, patient education, femoral inspection and echo. On post-ablation days 1 and 3, patients were called by the SDD coordinator to ensure well-being and good aspect of the femoral access site (smartphone foto control). In addition, patients could consult the SDD coordinator via mobile phone any time during working hours. In-person follow-up visits were scheduled at 2 weeks and 3, 6 and 12 months post-ablation. Results 420 consecutive patients were evaluated by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were lack of home support (4.5%), living remotely (6.9%), or LVEF <35% (4.0%). 300 of the eligible patients (91%) were successfully discharged the same day (Fig. 1). Rates of unplanned medical attention (4.0%) and 30d-readmission (1.6%) were extremely low. Importantly, there was no major post-SDD complication. Unplanned medical attention and hospital readmissions were largely driven by minor femoral access site complications. Of note, those were significantly reduced upon introduction of mandatory ultrasound-guided puncture after the first 150 SDD patients (p=0.0145, Fig. 2). SDD coordination by the advanced practice nurse streamlined patient flow and in-hospital logistics and significantly reduced the total workload of nursing and medical staff. This resulted in great acceptance of the SDD program and satisfaction both among staff and patients. Conclusions Advanced practice nurse-coordinated SDD after AF ablation is safe and efficient. In fact, the position of a dedicated coordinator may be a key in the forthcoming transition of hospitals to SDD. Importantly, ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.Figure 1Figure 2