Can J Cardiol. 2020 Aug 22:S0828-282X(20)30920-X. doi: 10.1016/j.cjca.2020.08.012. Online ahead of print.
Although the incidence of ST-elevation myocardial infarction (STEMI) is on the decline, management of patients presenting with STEMI continues to require significant healthcare resources. Earlier hospital discharge in low-risk patients presenting with STEMI has been an area of focus in an attempt to reduce healthcare costs. As a result, discharge within 48-72 hrs following successful primary PCI has increasingly become routine practice. Moreover, the current COVID-19 pandemic has led to enormous pressure on healthcare systems to find ways to increase bed-capacity, preserve resources, and reduce the risk of exposure to patients and healthcare workers. In response to this goal, the Ottawa Heart Institute has developed and implemented a novel Very Early Hospital Discharge (VEHD) protocol. The VEHD protocol is a simple, four-step algorithm designed to accurately and efficiently identify low-risk STEMI patients that can be safely discharged between 20 and 36 hours after successful primary PCI. Once deemed eligible for VEHD pre-discharge tasks are completed by the treating medical and nursing team and the patient is discharged home. Follow-up is completed remotely via through virtual care (48-hours, 7-days, 30-days), and in the outpatient cardiology clinic (4-6 weeks). Amid a worldwide COVID-19 pandemic we believe the VEHD protocol is a crucial step in maintaining exceptional quality of care, both in terms of patient satisfaction and clinical outcomes, while concurrently lowering the risk of nosocomial infections, and reducing resource utilization.