Protocol to Identify Patients Eligible for Early Hospital Discharge After PCI for STEMI

A 4-step protocol was found to accurately and efficiently identify patients with ST-elevation myocardial infarction (STEMI) who are at low risk and can be safely discharged after successful primary percutaneous coronary intervention (PCI), according to a study published in the Canadian Journal of Cardiology.

In response to the coronavirus disease 2019 (COVID-19) pandemic, researchers at the Ottawa Heart Institute developed the Very Early Hospital Discharge (VEHD) protocol. The 4-step algorithm is based on studies in which clinical events following early hospital discharge of patients with STEMI were evaluated. The protocol is designed to ensure the safe discharge of patients who are provided with guideline-directed medications, adequate predischarge education, and appropriate outpatient follow-up.

“Amid a worldwide COVID-19 pandemic we believe the VEHD protocol is a crucial step in maintaining exceptional quality of care, both in terms of patient satisfaction and clinical outcomes, while concurrently lowering the risk of nosocomial infections, and reducing resource utilization,” noted the study authors.

Step 1 of the protocol involves ensuring that the patient meets all required eligibility criteria. Step 2 involves enrolling the patient in the VEHD program and completing all of the predischarge tasks, which are assigned to either the attending physician/primary medical team or the patient’s nurse.

In step 3, a trained telehealth nurse performs follow-up telephone calls with the patient 48 hours, and 7 and 30 days after discharge to assess the occurrence of postprocedural complications, confirm medication tolerance/adherence, counsel, and answer questions. Step 4 consists in a virtual or in-person outpatient clinic visit with the interventional cardiologist who performed the procedure. All patients enrolled in the VEHD program are prospectively followed until the time of their cardiology clinic visit as part of a quality assurance initiative.

“The past several months have forced healthcare systems across the globe to re-evaluate current methods for delivering care, and in many cases have revealed inefficiencies in our current systems,” noted the study authors. “While the COVID-19 pandemic was the impetus for introducing the VEHD protocol, the available literature, in addition to our initial data, suggest that this change may enable clinicians to maintain exceptional quality of care — both in terms of patient satisfaction and clinical outcomes — while simultaneously lowering the risk [for] nosocomial infections, and reducing resource utilization.”

Reference

Marbach JA, Alhassani S, Chong A-Y, et al. A novel protocol for very early hospital discharge following STEMI [published August 22, 2020]. Can J Cardiol. doi:https://doi.org/10.1016/j.cjca.2020.08.012