When caseloads of coronavirus disease (COVID-19) began climbing in March 2020, many of New York City’s cardiac electrophysiology (EP) practices were forced to shut down in order to protect their patients from contagion and conserve resources for the pandemic’s victims. NYU Langone Health’s Heart Rhythm Center was able to continue operating safely throughout the crisis, thanks to new protocols enabling same-day discharge for the majority of catheter-based procedures.
New Vascular Closure Technology Spurs a Broad Change of Approach
One of the busiest arrhythmia practices in the nation, the center is led by Larry A. Chinitz, MD, the Alvin Benjamin and Kenneth Coyle Sr. Family Professor of Medicine and Cardiac Electrophysiology, clinical director of the Leon H. Charney Division of Cardiology, and director of cardiac EP. Shortly before the pandemic arrived, he and his team were investigating an advanced vascular closure technology designed to decrease time to ambulation after catheter ablations.
With conventional manual compression, patients required four to six hours of bed rest before ambulation; they were then transferred to a recovery unit, where they remained overnight before discharge. The new device, whose safety and efficacy had been established in a multicenter clinical trial, enabled patients to ambulate in only two hours—and, if their condition allowed, to go home soon afterward.
With the COVID-19 crisis looming, the team recognized that earlier discharges might offer the solution to an urgent problem: how to continue providing necessary treatments without interruption. “We have a lot of patients who are dependent on our work,” says Dr. Chinitz, who has long been known as a pioneer of novel devices and techniques for treating complex arrhythmias. “Cardiac disease is not something that you can just close the door on.”
“Our cardiologists are always looking for ways to use state-of-the-art technology, and their own ingenuity, to enhance care and the patient experience.”—Glenn I. Fishman, MD
The Heart Rhythm Center quickly integrated the vascular closure device with an array of operational efficiencies, enabling the majority of ablation patients to be discharged the same day directly from the cardiac EP service itself, rather than from a separate floor. Nurse practitioners were assigned to call patients the following morning to check on their recovery and address any questions or concerns.
“Besides shortening length of stay, the new protocols protected our patients and staff from exposure to potentially infectious individuals in other units,” Dr. Chinitz explains. “That allowed us to keep operating safely, while freeing up resources in those units for coronavirus care.”
Once the system was in place for ablation patients, the EP team began developing similar protocols for patients receiving cardiac devices such as pacemakers and implantable cardioverter defibrillators. The timing of preoperative echocardiograms, chest X-rays, and device interrogation was optimized to accelerate workflows; postoperative patients were encouraged to sit upright within one hour, and to walk within two.
By June, more than 60 percent of complex ablation patients, and approximately 75 percent of EP lab patients overall, were being discharged on day 0.
Pandemic-Inspired Protocols Bring Lasting Enhancements in Care
As the months passed, the new techniques and protocols proved to have an added benefit: patient satisfaction scores rose significantly. “Patients who’d been through previous procedures told us they were happy to get up and moving sooner, instead of lying on their backs for six hours,” Dr. Chinitz says. “They were thrilled to get out of the hospital more quickly.”
The results of these changes are being analyzed as part of a three-year study of outcomes and patient response at the Heart Rhythm Center; initial data will be published in a journal paper currently under review. Based on the early findings, Dr. Chinitz expects that same-day discharge will remain the center’s standard of care for catheter-based procedures going forward. “We’ve learned a lot from this adaptation that has changed our practice,” he says, “and that will persist even after the pandemic dies down.”
The changes also reflect the broader mission of NYU Langone’s Leon H. Charney Division of Cardiology. As director Glenn I. Fishman, MD, the William Goldring Professor of Medicine at NYU Grossman School of Medicine and vice chair for research in the Department of Medicine, explains, “Our cardiologists are always looking for ways to use state-of-the-art technology, and their own ingenuity, to enhance care and the patient experience.”