Enhancing efficiency in length of stay for ventricular assist device patients during routine right heart catheterization

Emad Hakami; Ahlam H. Alsomali; Mosaad Alhussein

doi:10.18203/2320-6012.ijrms20252770

Authors

Emad Hakami Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Ahlam H. Alsomali Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Mosaad Alhussein Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252770

Keywords:

Ventricular assist device, Right heart catheterization, Length of stay, Quality improvement, Virtual clinic

Abstract

Background: Left ventricular assist device (LVAD) patients undergoing right heart catheterization (RHC) were traditionally admitted pre- and post-procedure for inpatient anticoagulation bridging. From 2021 to 2025, transition to outpatient RHC and eliminate length of stay (LOS) using an IACT-PDCA initiative enhanced with virtual ventricular assist device (VAD) clinic reminders.

Methods: In 2021-2024, patients were instructed to complete international normalized ratio (INR) testing 3 days before RHC. In early 2025, a retrospective review revealed cancellations due to missed INR testing. Consequently, we integrated a virtual VAD clinic in 2025, with reminders initiated 7 days prior to ensure timely INR testing.

Results: LOS was reduced to zero days; INR-related cancellations were nearly eliminated. Estimated cost savings totaled ~875,744 SAR.

Conclusions: A staged quality improvement approach using IACT-PDCA and virtual care effectively transformed RHC workflow into a sustainable outpatient model.

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References

Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010;29(4):S1-39. DOI: https://doi.org/10.1016/j.healun.2010.01.011

Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability:“She was probably able to ambulate, but I’m not sure”. JAMA. 2011;306(16):1782-93. DOI: https://doi.org/10.1001/jama.2011.1556

Grady KL, Meyer PM, Mattea A, White-Williams C. Improvement in quality of life outcomes 1 year after LVAD implantation. J Heart Lung Transplant. 2018;37(5):535-43. DOI: https://doi.org/10.1016/j.healun.2007.01.042

Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. J Med Internet Res. 2015;17(2):e52. DOI: https://doi.org/10.2196/jmir.3951

Sharma A, Tran TTT, Brice J, Cavendish J, Cosgriff J, Coriell M, et al. A virtual anticoagulation clinic: Implementation and evaluation of a pharmacist-led model during COVID-19. Front Cardiovasc Med. 2021;8:648265. DOI: https://doi.org/10.3389/fcvm.2021.648265

Angraal S, Krumholz HM, Schulz WL. Digitizing the next generation of clinical quality measures. J Am Med Inform Assoc. 2020;27(3):466-72.

Neubeck L, Hansen T, Jaarsma T, Klompstra L, Gallagher R. Delivering healthcare remotely to cardiovascular patients during COVID-19: A rapid review. Eur J Cardiovasc Nurs. 2020;19(6):486-94. DOI: https://doi.org/10.1177/1474515120924530

Alotaibi Y, AlSaad SM, Aljuaid M, Alshehri D, Almalki M. Patient satisfaction with virtual clinics during the COVID-19 pandemic: A cross-sectional study. BMC Med Inform Decis Mak. 2021;21(1):1-9.

Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, et al. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA. 2011;305(21):2175-83. DOI: https://doi.org/10.1001/jama.2011.697

Shehab A, AlSinani M, AlHarthi K, Al Mahrouqi A, Al Abri M, Al Hashmi K. Outcomes of virtual heart failure clinics during the COVID-19 pandemic: An international experience. ESC Heart Fail. 2021;8(3):2225-32.

Matchar DB, Jacobson A, Dolor R, Edson R, Uyeda L, Phibbs CS, et al. The impact of patient self-testing of prothrombin time for managing anticoagulation: A systematic review. Evid Rep Technol Assess. 2009;(169):1-152.

Alasmari F, Alanazi M, Almalki M, Alotaibi R. Evaluation of a tele-cardiology program in a tertiary care center in Saudi Arabia. J Telemed Telecare. 2022;28(5):330-6.

Kahn JM, Cicero BD, Wallace DJ, Iwashyna TJ, Pike F, Weissfeld LA. Adoption and perceived effectiveness of telemedicine in US ICUs. Crit Care Med. 2014;42(2):364-70. DOI: https://doi.org/10.1097/CCM.0b013e3182a6419f

Bland KA, Srinivasan S, Sinha N, MacIntyre CR, Williamson M, Ralph AP. Virtual care models for heart failure: A systematic review and meta-analysis. Can J Cardiol. 2021;37(7):1186-95.

Al Ammari M, Al Mogbel Y, Al Qahtani N, Al Harbi M, Al Anazi S, Al Mutairi N. Implementation of a tele-pharmacy anticoagulation clinic during COVID-19: A single-center experience from Saudi Arabia. Front Pharmacol. 2021;12:652482. DOI: https://doi.org/10.3389/fphar.2021.652482

Chaves PHM, Varadhan R, Lipsitz LA, Stein PK, Tian J, Windham BG, et al. Physiological complexity underlying heart rate dynamics and frailty status in older adults. J Gerontol A Biol Sci Med Sci. 2008;63(5):524-30.

Marcolino MS, Maia JX, Alkmim MB, Boersma E, Ribeiro AL. Telemedicine application in the care of diabetes patients: Systematic review and meta-analysis. PLoS One. 2013;8(11):e79246. DOI: https://doi.org/10.1371/journal.pone.0079246

Wegier P, Koo E, Ansari S, Moore J, Sud M, Bell CM, et al. Experience of central monitoring in a COVID-19 virtual hospital program: A mixed-methods study. J Gen Intern Med. 2022;37(6):1404-11.