Changing the model of care during the COVID-19 pandemic: Same-day discharge of patients undergoing elective invasive cardiac procedures in Hong Kong.
Cecilia Miu-Ching Chan, Michael Kang-Yin Lee, Alan Ka-Chun Chan and 2 others
PMID 34428737WHAT IT FOUND
In carefully selected low-risk patients having invasive intracoronary procedures, the 106 patients discharged same day had no adverse events and lower 30-day readmission than after overnight stay; mortality was not different.
Key findings
01Same-day discharge increased from 38 patients (10.1%) in 2019 to 68 patients (22.4%) in 2020, p < 0.001.
02No adverse clinical events were identified among the 106 patients in the same-day discharge cohort.
03Thirty-day readmission was 0% in the same-day cohort and 8.9% in the overnight cohort, p < 0.001; mortality was 0% and 0.3%, p = 1.000.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and observational, so clinicians chose who was discharged; it cannot prove same-day discharge caused the outcomes. The same-day group was small: 106 patients, and all were selected by protocol as low-risk, so the absence of adverse events may not apply to higher-risk patients. It was a single centre in Hong Kong with experienced operators, so results may not transfer to other settings. Only short-term outcomes were reported, up to 30 days; longer-term complications were not followed. Frailty was assessed by subjective eyeball observation, which may have varied between nurses and could affect selection. The study did not capture all procedural decisions, such as reperfusion flow or stent location.
Declared interests
The authors reported no potential conflict of interest and no competing interests.
The easy way to misread this
Do not read the absence of adverse events or the lower readmission rate as proof that same-day discharge is safe for all patients after invasive intracoronary procedures. Only 106 carefully selected patients were discharged on the same day, and the study was observational, so the outcomes may reflect selection, protocol education, caregiver availability and next-day follow-up rather than the discharge itself.