Introduction:
Catheter ablation is a common procedure used to treat arrhythmias such as supraventricular tachycardia (SVT) and atrial fibrillation (AF). One of the key benefits of catheter ablation is the possibility of same-day discharge, where patients can undergo the procedure and return home on the same day. This approach can enhance hospital throughput, reduce healthcare costs, and improve patient satisfaction. However, despite its potential benefits, same-day discharge remains underutilized in many healthcare systems worldwide. This study by Sheldon M. Singh and Suzette Turner from the Sunnybrook Health Sciences Centre sought to evaluate ways to increase same-day discharge after catheter ablation procedures and assess the factors contributing to its underuse.
The Study:
The study took place at Sunnybrook Health Sciences Centre, a major cardiac center in Toronto, Ontario, Canada. It aimed to test a simple quality improvement intervention: sending monthly emails to physicians with performance feedback on same-day discharge rates after SVT ablation procedures. The goal was to encourage physicians to consider discharging patients on the same day as the procedure, which could help reduce hospital bed occupancy and overall treatment costs.
The study spanned from April 2018 to June 2023, with the intervention period beginning in November 2019. During the intervention period, physicians performing catheter ablation procedures for SVT received monthly emails containing performance data on same-day discharge rates. These emails were supplemented by a patient information form that served as a reminder for physicians to consider same-day discharge before performing the procedure.
The study also compared the effects of the intervention on SVT ablation to its impact on AF ablation, a more complex procedure for which no intervention was implemented. By tracking both procedures, the researchers aimed to assess whether the changes observed were specific to the SVT ablation intervention or if there were broader trends that could be attributed to external factors, such as the COVID-19 pandemic.
Key Findings:
- Impact of the Intervention: The study found a significant increase in the rate of same-day discharge for SVT ablation procedures during the intervention period. The proportion of SVT patients discharged on the same day rose from 64% to 91% over the course of the study. This change was attributed to the intervention, suggesting that providing performance feedback to physicians can be an effective strategy for improving same-day discharge rates.
- The COVID-19 Pandemic’s Role: A surprising finding was the increase in same-day discharge for AF ablation procedures during the same period. While no intervention was introduced for AF procedures, the rate of same-day discharge increased from 9% to 91%. This raised the question of whether the observed changes were due to the intervention or if other factors, such as the COVID-19 pandemic, played a significant role. The researchers speculated that the increase in same-day discharge for AF ablation procedures might be attributed to the Hawthorne effect, where physicians alter their behavior because they are aware that their actions are being observed. However, the study also highlighted that the pandemic, which led to hospital restrictions and a focus on minimizing inpatient admissions, likely had a larger influence on discharge practices. During the pandemic, hospitals were forced to adopt strategies to reduce the length of hospital stays, which may have naturally led to an increase in same-day discharges.
- Analyzing the Data by Time Period: The researchers divided the study period into four discrete time frames to evaluate the rate of change in same-day discharge across different phases:
- Period 1 (Pre-Intervention and Pre-COVID, April 2018 to October 2019): There was minimal change in same-day discharge rates for both SVT and AF procedures during this period.
- Period 2 (Post-Intervention and Pre-COVID, November 2019 to March 2020): The rate of same-day discharge for SVT ablation rose significantly, suggesting that the intervention had a positive effect.
- Period 3 (During COVID-19, April 2020 to May 2022): Both SVT and AF ablation procedures saw an increased rate of same-day discharge, with AF ablation showing the most significant growth. This period coincided with hospital restrictions, suggesting that the pandemic likely played a major role in encouraging shorter hospital stays.
- Period 4 (Post-COVID, May 2022 to June 2023): The rates remained relatively high, indicating that some of the practices adopted during the pandemic continued even after restrictions were lifted.
Discussion:
The study’s findings shed light on multiple factors influencing same-day discharge after catheter ablation procedures. The intervention itself — monthly emails with performance feedback — led to a measurable improvement in same-day discharge rates for SVT ablation. This suggests that simple, non-punitive interventions (like feedback emails) can be an effective way to encourage physicians to adopt practices that improve efficiency and patient flow.
However, the significant increase in same-day discharge rates for AF ablation during the same period raises questions about the role of the Hawthorne effect — a phenomenon where individuals modify their behavior simply because they are being observed. The researchers hypothesized that the awareness of being observed might have led physicians to increase the use of same-day discharge for both SVT and AF procedures. However, this explanation is complicated by the timing of the study, which overlapped with the onset of the COVID-19 pandemic.
The pandemic may have acted as a powerful external driver, influencing discharge practices across the board. During the pandemic, hospitals were under significant pressure to minimize inpatient stays to free up bed space for COVID-19 patients. This likely led to a natural increase in same-day discharges, even in cases like AF ablation, where no intervention was implemented.
The study also highlights the importance of considering broader healthcare system changes when evaluating interventions aimed at improving care practices. In this case, the pandemic likely had a far-reaching influence on discharge behaviors, possibly overshadowing the effects of the intervention itself.
Conclusion:
This study provides valuable insights into the factors that influence same-day discharge after catheter ablation procedures. While the intervention (monthly feedback emails) likely contributed to the increase in same-day discharge for SVT ablation, the COVID-19 pandemic played a significant role in accelerating these changes, particularly for AF ablation. The findings suggest that healthcare institutions can benefit from simple interventions to encourage same-day discharge, but they must also consider external factors — like the pandemic — when interpreting the results of such interventions.
In conclusion, this study underscores the complex interplay between physician behavior, institutional interventions, and external factors like public health crises. It provides a model for future quality improvement initiatives in hospital discharge practices and highlights the need for further research to better understand the impact of the pandemic on healthcare delivery.
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Source:- https://jhmhp.amegroups.org/article/view/9384/html
