Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory in Belgium: Value Based Healthcare-Change in Practice.

Aims: To assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital.
Methods and Results: Outcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021. The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income.
Conclusion: Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.
Competing Interests: Conflict of interest Dr. Collet reports receiving research grants from Biosensor, GE Healthcare, Medis Medical Imaging, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow. and Abbott Vascular; and consultancy fees from HeartFlow, Opsens, Pie Medical Imaging, Abbott Vascular and Philips. Dr. De Bruyne has an institutional consulting relationship with Boston Scientific, Abbott Vascular, CathWorks, Siemens, GE Healthcare, and Coroventis Research; receives institutional research grants from Abbott Vascular, Coroventis Research, CathWorks, Boston Scientific; and holds minor equities in Philips, Siemens, GE Healthcare, Edwards Life Sciences, HeartFlow, Opsens, and Celiad. Dr. Wyffels has an institutional consulting relationship with Siemens. Dr. Barbato reports receiving honoraria for presentaions and support for attending meetings from Abboth Vascular, Boston Scientific, Insighht Lifetech. Dr. Esposito and Dr. Bertolone reports research grant from the CardioPaTh PhD Program.
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