Changing and Sustaining an Evidence-Based Quality Improvement Initiative for Same-Day Discharge with Cardiac Implantable Electronic Device Patients

Abstract

Previous studies have demonstrated that same-day discharge (SDD) in cardiac implantable electronic devices (CIED) is feasible and safe. While SDD protocols have been successfully adopted at other hospitals within the system, they have yet to be implemented at a community tertiary care hospital in the southeastern United States of America. This evidence-based quality improvement (EBQI) initiative aimed to implement SDD protocol for patients receiving CIEDs to improve hospital throughput and reduce costs while maintaining safe, high-quality care. Using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEP) and the Plan-Do-Study-Act (PDSA) quality improvement model, this initiative identified best practices for implementing SDD in CIED patients. Results demonstrated a reduction in length of stay and financial cost savings without compromising patient safety or care quality. After initiative implementation, there was a decrease in readmission rates, no deaths, a decrease in complications, and an increase in SDD in CIED patients. Return on investment $68,684 in cost savings achieved during the first 180 days of implementation, with potential for further financial benefits system-wide. This initiative highlights the use of evidence-based practice coupled with stakeholder engagement, staff education, and continuous process improvement while utilizing remote monitoring and telemedicine for post-discharge follow-up. These strategies have demonstrated that SDD for CIED patients is a safe, effective, and cost-efficient intervention, positively impacting both patient outcomes and organizational performance.A one-year embargo was granted for this item