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Ablation is an increasingly prevalent treatment for atrial fibrillation. Hospital resource limitations, including bed availability, a barrier to utilization. Strategies to facilitate same-day discharge (SDD) following ablation has become increasingly relevant.
Objective
To improve rate of same-day discharge without compromising safety.
Methods
We examined SDD rates for AF ablation at our institution (Ottawa Heart Institute) and implemented an ‘AF bundle’ to improve SDD while maintaining safety. Program included 8-month review period; 4-month development and implementation; and 3-month post-assessment. Intervention bundle included: up-front SDD eligibility assessment; short-term interruption of DOAC; use of a Figure of 8 suture; early ambulation; standardized post-procedure assessments. A X2 test with significance <.05 was used to compare SDD rates.
Results
We found a pre-intervention SDD rate of 47% (62 of 131 procedures) and post-intervention rate of 64% (46 of 72 procedures) which was significantly greater (p=.02). Of patients planned for SDD, 17% converted to overnight stays. Reasons included prolonged procedure, complications, post-anesthesia concerns, and patient preference. Most common reasons for planned overnight stays included: patient preference, severe comorbidities, and anticipated late finish. For SDD cases, average time from procedure end to discharge was 6h53m. Procedural complications and ED visits within 10 days were not increased (10% pre vs 5% post).
Conclusion
Same-day discharge rates following atrial fibrillation ablation can be safely increased via local quality improvement initiatives.
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