Key result
Qualitative interviews identified patient factors, provider factors, and transitions to outpatient care as the primary root causes for delayed hospital discharge in STEMI patients.
Delayed hospital discharge post-STEMI is driven by patient factors, provider experience, and outpatient transition challenges, which are not captured by current risk stratification tools like the Zwolle score.
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Identified factors should not yet change discharge protocols; leaves open prospective trials of targeted interventions.
BACKGROUND: The majority of patients who suffer a ST-segment myocardial infarction (STEMI) are hospitalized for longer than 48 h. With the advent of reperfusion therapy, the benefits of such extended hospitalization has been questioned. The goal of this qualitative study was to identify the root causes for prolonged hospitalization in STEMI patients in order to refine future interventions to optimize the length of hospitalization. METHODS: Practitioners involved in the discharge process for STEMI patients at a single tertiary care STEMI center underwent semi-structured interviews focused on three fictional patient cases. Data were transcribed and analyzed for key themes by thematic analysis. RESULTS: Interviews were conducted with 17 practitioners (5 Attending Physicians, 4 Internal Medicine Residents, 4 Cardiology Residents, 4 Nursing Staff). The key themes were patient factors, provider factors, and transitions to outpatient care. Patient factors included concerns that early discharge would limit dose titration of medications, the educational experience of the patient, and prevent monitoring for complications. Provider factors included past clinical experience with STEMI complications, in turn impacting discharging behaviour. Transitions of care factors were difficulty in establishing reliable follow-up plans and home care services. CONCLUSIONS: Several themes were identified that influence the timing of discharge post STEMI. The majority of these issues are not incorporated into currently available post STEMI risk stratification tools. Future quality improvement interventions to reduce STEMI length of stay should focus on in-patient and out-patient strategies to address these unique clinical situations.
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Adams et al. (2015) studied ST-segment Myocardial Infarction (STEMI) (n=17). Qualitative analysis of discharge practices was evaluated on Root causes for prolonged hospitalization in STEMI patients. Qualitative interviews identified patient factors, provider factors, and transitions to outpatient care as the primary root causes for delayed hospital discharge in STEMI patients.
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