Impact of a nurse-led same day admission pathway on hospital length of stay for transcatheter aortic valve implantation

Abstract

Background/Aims Patients undergoing transcatheter aortic valve intervention are commonly admitted the day before their procedure. Same-day admission offers a potential approach to reduce length of stay and procedural costs but there are little data on the feasibility and safety of this approach. This study aimed to explore the feasibility and safety of a same-day admission programme facilitated by a specialist nurse for patients undergoing elective transfemoral transcatheter aortic valve implantation. Methods Consecutive patients undergoing transcatheter aortic valve implantation through a standard care pathway (admission to hospital before the day of procedure) from July 2015 to July 2016 were retrospectively compared to those going through a same-day admission pathway from April 2017 to December 2018 at the James Cook University Hospital. Baseline and procedural characteristics, length of stay and clinical outcomes were analysed using chi square, Student's t-test and Mann–Whitney U tests. Results Overall, 121 of 135 (90%) patients were eligible for same-day admission and all underwent successful same-day transcatheter aortic valve implantation. There were 77 patients in the standard care group. Average length of stay in the same-day group was lower than the standard care group (1.5 vs 3.9 days; P<0.01) with no differences in mortality, procedural complications or readmission within 30 days between the two groups. Conclusions Routine same-day admission for transfemoral transcatheter aortic valve implantation facilitated by a specialist nurse can be safely implemented, leading to a shorter length of stay with no detrimental effect on clinical outcomes. This represents a highly effective method of reducing the procedural cost of transcatheter aortic valve implantation.