Indiana Chapter-ACC Launches Best Practices
The Indiana Chapter of the American College of Cardiology launches its Best Practices & Innovation in Medicine Sessions, with Dr. Parin Patel, the new governor, introducing the initiative. Dr. Chandra Kumbar, an electrophysiologist from Southern Indiana, is the guest speaker for this first session. Both doctors express enthusiasm for the opportunity to share innovative ideas and practice-changing innovations across the state, emphasizing the importance of learning from each other.

Same-Day Discharge Practices in Electrophysiology
Parin and Chandra discussed best practices in electrophysiology, focusing on same-day discharge procedures. Chandra shared that COVID-19 accelerated the shift towards same-day discharge for routine device implants, initially done overnight due to internal anesthesia. They now consider patients for discharge if they’ve been in the system for more than six hours. The conversation aimed to learn from each other’s experiences and potentially adapt these practices.

Same-Day Discharge Criteria for Procedures
Chandra discussed the criteria for same-day discharge for patients undergoing procedures. He mentioned that patients with ischemic valve ablation, concomitant ablation and watchman procedures, or those with low ejection fraction or requiring assistance for ambulation, are typically kept overnight. However, for other patients, the decision to discharge them the same day depends on factors such as the time of the procedure, the patient’s support system, and the distance they need to travel. Chandra also mentioned the use of a cardiovascular observation unit for monitoring patients. Parin agreed with Chandra’s points and emphasized the importance of considering patient-specific, procedure-specific, and hospital-specific factors when deciding on same-day discharge.

Setting Expectations for Patient Safety
Chandra discussed the importance of setting expectations and prioritizing patient safety during procedures. He explained that patients and their families are more comfortable when they understand the decision-making process and the reasons for keeping them or sending them home. Chandra also highlighted the importance of having open conversations about expectations before the procedure. Parin agreed, emphasizing the need for clear communication to ensure patient satisfaction. They also discussed the varying preferences of patients, with some preferring to go home the same day and others prioritizing safety.

Prioritizing Patients for Efficient Discharge
Chandra discussed the operational efficiency of prioritizing patients based on their needs, with those requiring more help in the second half of the day and those who could potentially be discharged earlier. He also mentioned the use of closure devices for early discharge, especially for patients ready to go home within 4 to 6 hours. Parin added that closure devices can now be used in both arteries and veins for ablation procedures, facilitating early ambulation. They also discussed the influence of PFA on same-day discharge, with Chandra noting that most early morning PFA patients are sent home and are allowed to drink plenty of water in the recovery area, reducing the need for IV hydration.

Non-Invasive Monitors and Foley Catheters
Chandra and Parin discussed the use of non-invasive arterial blood pressure monitors and the potential benefits of same-day discharge for patients undergoing procedures. Chandra shared that while they have not implemented the non-invasive monitors, they are considering it for future use. They also discussed the use of Foley catheters, with Parin expressing concern about urinary retention risks. Chandra mentioned that they monitor patients overnight if they experience difficulty voiding. They also discussed the importance of setting clear expectations and having a defined post-discharge follow-up plan to alleviate patient concerns.

Consistent Communication and EP Team Support
Chandra and Parin discussed the importance of consistent communication with patients, particularly on weekends. They emphasized the need for early follow-up and constant contact after discharge to ensure patient comfort and address any concerns. Chandra also highlighted the value of having a dedicated EP team on call 24/7, which includes physicians and nurse practitioners, to provide immediate support and answer patient queries.

Team-Based Care in Hospitals and Post-Discharge
Chandra and Parin discussed the importance of team-based care in hospitals and post-discharge, emphasizing the need for constant communication and follow-up. They identified patient-specific factors, procedure-specific factors, and hospital-based factors that could influence the success of same-day discharge. Chandra highlighted the need for staff training to manage rare complications and the importance of learning from past mistakes. Parin emphasized the complexity of the procedures and the need for expertise, despite improvements in safety and efficiency.

Team-Based Approach to Patient Care
Parin and Chandra discussed the benefits of a team-based approach to patient care, emphasizing the importance of having a nurse who can handle late discharges and address patient concerns. They also touched on the cost-effectiveness of same-day discharges and the potential pressure from hospital systems to increase this practice. Chandra highlighted the time-saving aspect of using traditional methods like figure-of-8 devices over newer technologies. The conversation concluded with Parin and Chandra agreeing on the value of old methods in some cases.