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To improve patient access and efficiency of care, Mayo Clinic Rochester began offering cardiac catheterization (cath) services on Saturdays beginning 1/1/2009 for non-emergent inpatients. We assessed the economic and clinical impact of this increased weekend cath service availability (CSA).
Adult cohorts undergoing cath for a non-STEMI indication pre- and post-CSA were identified in clinical databases and compared. These included all Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from 1/1/2007 to 12/31/2008 (pre-CSA events) and patients with a Friday or Saturday admission undergoing cath the subsequent Saturday from[[Unable to Display Character:
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331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients) were identified. The cohorts were similar in age (66 years), sex (59% male), primary admission diagnosis, and level of comorbidity. PCI use was significantly higher following CSA (42% vs. 26%; p<0.001). Inhospital mortality was rare and similar pre- and post-CSA (1.8% vs. 2%; p=0.58). Rates of revascularization and MI during 30 days follow-up were also similar (10% vs. 9%; p=0.76 and 10% vs. 12%; p=0.51). Procedural success was similarly accomplished in 95% and 94% of pre- and post-CSA patients, respectively, undergoing PCI. Mean LOS was reduced 1.8 days following CSA (5.7 vs. 3.9 days) yet mean inpatient costs were slightly higher ($478, $24,880 vs. $24,402; 95% confidence interval of difference: $467 to $490).
Weekend CSA for routine inpatients was clinically safe and effective and reduced hospital LOS. Costs increased almost $500 per hospital episode, which likely reflects selection bias in this non-randomized study with a higher utilization of PCI following CSA.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: AMI and PCI
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1158-100
- 2013 American College of Cardiology Foundation