2022 Quality Summit ePosters (Non-CE) - STS/ACC TVT Registry-1. Reducing Length of Stay for Patients Undergoing Transcatheter Aortic Valve Replacement in a High-Volume Intercity Hospital Utilizing a Pre-screening Approach: A Quality Improvement Project

1. Reducing Length of Stay for Patients Undergoing Transcatheter Aortic Valve Replacement in a High-Volume Intercity Hospital Utilizing a Pre-screening Approach: A Quality Improvement Project

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Pdf Summary

The document discusses a quality improvement initiative aimed at reducing the length of stay (LOS) for patients undergoing post-procedure protocols in healthcare. The initiative focused on standardizing the post-procedure pathway, removing barriers to next day discharge (NDD), and establishing a pre-identification checklist. The mean LOS for retrospective patients who would have qualified for the protocol was 2.1 days, while for qualified prospective patients included in the protocol, it was 1.6 days. There was a significant reduction in LOS for patients enrolled in the NDD protocol, with a decrease of 0.5 days. The screening tool used to determine candidates for NDD had an 89% success rate.<br /><br />The document outlines the roles and impacts of various team members involved in the initiative. This includes clinical coordinators responsible for setting patient expectations and evaluating candidacy, schedulers ensuring appropriate scheduling of procedures and imaging, non-invasive imaging teams performing post-procedure imaging, nurse practitioners conducting candidacy screening and ensuring timely rounds and imaging, attending physicians overseeing timely rounds for early discharge, and hospitalists or discharging physicians collaborating with the procedural team for timely discharge.<br /><br />The document also discusses the establishment of a NDD protocol, including pre-identifying eligible patients, pre-scheduling post-procedure imaging, and pre-educating patients for NDD. Recommendations for reducing LOS include staff engagement, consistent physician rounding schedules, discussing patient eligibility during team conferences, documenting eligibility for easy identification, partnering with non-invasive imaging for timely completion of imaging, ensuring patient expectations are aligned with NDD, and establishing a cohesive relationship with discharging physicians.<br /><br />The inclusion and exclusion criteria for the NDD protocol are also provided, including age requirements, access methods, outpatient admission, absence of certain conditions, and frailty indicators. The document concludes that the implementation of the NDD protocol successfully reduced LOS but acknowledges the need for further improvement. The interventions utilized in the protocol need to be reimagined for continued reduction in LOS.<br /><br />Overall, the document highlights the importance of streamlining the post-procedure discharge process for patients undergoing TAVR procedures and emphasizes the need for a multidisciplinary team approach.

Keywords

length of stay

next day discharge

pre-identification checklist

retrospective patients

prospective patients

screening tool

NDD protocol

staff engagement

physician rounding schedules

multidisciplinary team