Accelerating the translation of evidence into practice: same day discharge following percutaneous coronary intervention

This invited commentary refers to ‘Prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention: a retrospective observational cohort study using routinely collected health data’, by Y. Chen et al., https://doi.org/10.1093/eurjcn/zvae125. The translation of research findings into clinical practice remains one of healthcare's most significant challenges, taking an average of 17 years for full adoption as standard of care.1,2 Significant lags in evidence translation may result in patient harm and economic consequences for both patients and hospital systems.2 Lack of adoption of protocols for same-day discharge (SDD) following elective percutaneous coronary intervention (PCI) serves as an exemplar of how an implementation gap can persist even when evidence to support this practice change is robust. Chen et al.'s3 study of the uptake of SDD in six Australian hospitals between 2013 and 2019 offers fresh insights into the adoption of SDD following elective PCI. Their finding of just 6.5% overall SDD adoption, despite evidence supporting SDD safety dating back to 2003, exemplifies how evidence alone often fails to change practice. The striking variation in SDD between hospitals (0–28.2%) further suggests that institutional factors, rather than clinical considerations alone, are influential in SDD adoption rates. Same-day discharge after elective PCI was found to be safe for select patients with stable angina undergoing femoral access PCI in a single-centre observational study published in 2003.4 Since then, subsequent studies found no significant increase in adverse events, including death, myocardial infarction, or rehospitalization, compared to overnight observation for low-risk patients discharged the same day following elective PCI,5–7 including among older adults.8 Randomized controlled trials and meta-analyses provided further confirmatory evidence of the safety of SDD following elective PCI.9–12 In 2021, the American College of Cardiology (ACC)13 released an expert consensus statement on SDD clinical pathways for patients following PCI following the 2018 consensus statement by SCAI14 recommending SDD as an option for patients who meet certain criteria. Despite the enlarging body of evidence supporting SDD, there remains significant variation in adoption of SDD with the prevalence of SDD marginally increasing globally over 20 years.14,15 Some increase in adoption of SDD was due in part to the increased use of radial access for PCI mitigating the need for extended observation related to femoral access.14 However, Chen et al.’s3 findings particularly highlight how change in access approach alone does not result in increased SDD. While 94% of SDD patients had radial access in their study, 54% of overnight stay patients had radial access but were not discharged on the same day. Given that radial access is used in a majority of the PCIs in the study, the disconnect between SDD recommendations for radial access and actual practice patterns reveals how deeply entrenched traditional care pathways remain. The implementation gap between SDD evidence and practice is driven by multiple factors. Providers often display understandable resistance to changing established practices, stemming from concerns about complications despite safety data, concerns regarding medicolegal consequences, and the natural inertia of established routines. System barriers such as lack of standardized protocols and limited resources may further hinder practice change. Financial disincentives from payers and insufficient coordination between hospital and community care may also prevent SDD. However, these barriers may vary significantly between systems, geographic regions, and countries making contextual analysis the key first step in overcoming barriers to SDD adoption. Implementation science offers valuable approaches to accelerate the adoption of evidence-based practices like SDD and incorporates contextual analysis prior to implementation.16,17 Successful implementation begins with the selection of an implementation framework to serve as guide for full practice change and then a systematic assessment of organizational readiness, identifying specific barriers, and mapping existing resources against implementation requirements. This preparatory work should include evaluation of current discharge processes and identification of modifications to the current process for successful implementation. Organizations such as ours that have successfully implemented SDD protocols engaged key stakeholders in the contextual analysis and protocol development. The development of standardized SDD protocols represents a crucial step in implementation but must be created through a collaborative process that ensures buy-in from all stakeholders. Successful protocols include clear patient selection criteria, standardized discharge processes, and well-defined roles for team members. However, protocols alone are insufficient to sustain practice change. Implementation requires robust support systems, including post-discharge follow-up processes and clear communication channels between hospital and community provider to allow for rapid identification and resolution of problems with the discharge process as they arise. Measurement and feedback mechanisms are vital to protocol sustainability. Organizations that have successfully implemented SDD programs establish systems for real-time data collection on patient outcomes and provide regular feedback to clinical teams. The data collected should encompass both clinical and economic outcomes, allowing organizations to demonstrate the value of SDD while ensuring patient safety. Such measurement systems support sustainability planning, helping organizations maintain practice change over time and adapt to challenges such as staff turnover and evolving clinical evidence. Future research should focus on comparing implementation strategies across institutions to identify key success factors that increase adoption of SDD. It is critical to better understand which implementation approaches are most effective in different contexts and how to scale successful implementations across healthcare systems. Chen et al.’s study serves not just as a documentation of implementation challenges but also a call to action for better understanding how to accelerate the translation of evidence into practice. Their key contribution lies not merely in demonstrating SDD safety—that evidence is already robust—but in quantifying the SDD implementation gap. The implementation of SDD following elective PCI represents more than just a change in discharge timing; it exemplifies the broader challenge of translating evidence into practice. By applying implementation science approaches, we may be able to narrow the average 17-year evidence-to-practice gap and advance patient care more rapidly. We must move beyond simply disseminating evidence to actively supporting healthcare organizations in implementing and sustaining evidence-based practice based on the latest research. Through careful attention to implementation science principles and systematic support for practice change, we can accelerate the adoption of evidence-based practices like SDD and ultimately improve patient care while optimizing healthcare resources. Sarah E. Slone (Conceptualization [lead]; Validation, Writing—original draft, Writing—review & editing [equal]), and Kurt G. Barringhaus (Validation, Writing—original draft, Writing—review & editing [equal]) None declared. No data was used to generate this publication.