Cardiovascular Rounds

Are you ready for same-day ICD discharge?

By Julie Bass

Much like same-day discharge after percutaneous coronary intervention (PCI), same-day discharge following elective ICD placement has many potential benefits – including increased bed availability, greater patient convenience and satisfaction, and the opportunity for cost savings. However, potential drawbacks of early discharge include the accentuation of mechanical complications, infection, and bleeding, among others.

A study recently published in the Journal of the American College of Cardiology (JACC) assessed the prevalence of same-day discharge after ICD placement and its associations with all-cause readmission, device-specific readmission, and death. Looking at a cohort of patients 65 years of age and older following elective ICD placement in the United States, the authors concluded same-day discharge was not significantly associated with death, all-cause readmission, or device-related readmission 90-days after discharge.

Related: Enhancing Hospital-Based Outpatient Services

Analysis from The Advisory Board Company reveals outpatient ICD placement is projected to increase in the upcoming years, along with a decrease in inpatient ICD placement.

National ICD Market Estimates

With the expected increase in outpatient volumes, it is critical for CV leaders to assess the opportunity for same-day discharge. While may ICD recipients discharged the same day with appropriate follow-up may have no heightened risk for adverse events, other high-risk patients need a longer observation period. There are currently no standardized criteria for same-day discharge published by professional societies.

Related: The Outmigration of Cardiovascular Services

As with any procedure, the discharge strategy following elective ICD placement should be prudently designed by the treating provider for each individual patient. The authors of the JACC study recommend that centers considering same-day discharge for ICD patients create protocols to identify eligible patients, monitor patients appropriately during recovery, and organize outpatient follow-up.

Learn more about the outpatient volumes in your service area

Access our Cardiovascular Outpatient Market Estimator tool to estimate the demand for CV outpatient services in your local market, and our Two-Midnight Rule Impact Assessment to identify Medicare cases potentially at risk for payment denial and which observation cases may be eligible for inpatient admission.

Profiles of Innovative CV Service Line Models

Join us on April 8 for in-depth case profiles of four institutions that have introduced innovative service line structures to meet their strategic goals of reorganizing around diseases, orienting toward outpatient care, scaling across sites, or promoting care redesign.