Kiemeneij F - AIMRADIAL 2013 - Outpatient

852 views
697 views

Published on

Radial lounge: the perfect combination for uncomplicated PCI

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
852
On SlideShare
0
From Embeds
0
Number of Embeds
215
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Kiemeneij F - AIMRADIAL 2013 - Outpatient

  1. 1. Radial lounge: the perfect combination for uncomplicated PCI Ferdinand Kiemeneij, MD, PhD Tergooi Hospital, Blaricum AIM RADIAL 2013
  2. 2. Radial lounge: the perfect combination for uncomplicated PCI WHY? Patient comfort Safety Logistics Reduces waiting lists Increased turn-over Cost-effectiveness AIM RADIAL 2013
  3. 3. Radial lounge: the perfect combination for uncomplicated PCI Following optimal transradial stent result, in absence of any complications in an 4-6 hours observation period, there is no CLINICAL need for prolonged 24 hours hospitalization AIM RADIAL 2013
  4. 4. Radial lounge: the perfect combination for uncomplicated PCI Experience with outpatient coronary stenting since 1994 J Am Coll Cardiol, 1997; 29:323-327 Outpatient coronary Palmaz Schatz stent implantation in 100 patients AIM RADIAL 2013
  5. 5. Radial lounge: the perfect combination for uncomplicated PCI Perfect result after elective PCI No complications Clinically stable Uneventful 4 hours observation Cardiac Vascular Suitable social circumstances AIM RADIAL 2013
  6. 6. Radial lounge: the perfect combination for uncomplicated PCI Perfect result after elective PCI Only the postPCI result counts • LM • CTO • Bifurcations • MVD AIM RADIAL 2013
  7. 7. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  8. 8. Radial lounge: the perfect combination for uncomplicated PCI Designed as airport business class lounge No beds Chairs, sitting corner, TV lounge, internet and PC’s, personal video/DVD/audio, reading table, self-service bar, etc. AIM RADIAL 2013
  9. 9. Radial lounge: the perfect combination for uncomplicated PCI Keep patient’s integrety intact Self supporting Mobile Not confined to bed Dressed AIM RADIAL 2013
  10. 10. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  11. 11. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  12. 12. Radial lounge: the perfect combination for uncomplicated PCI “HEALING ENVIRONMENT” The design of the healthcare environment can have a therapeutic effect on the patient. Environmental factors including lighting, colour, aroma, views, art, scale, proportion, sound, texture and materials – all play a powerful healing role. AIM RADIAL 2013
  13. 13. Radial lounge: the perfect combination for uncomplicated PCI “HEALING ENVIRONMENT” Light and color are the two aspects of sight that have greatest impact on a patient’s overall wellbeing. AIM RADIAL 2013
  14. 14. Radial lounge: the perfect combination for uncomplicated PCI 16 meter 13 meter AIM RADIAL 2013
  15. 15. Radial lounge: the perfect combination for uncomplicated PCI Lounge OLVG opened in 2006 AIM RADIAL 2013
  16. 16. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  17. 17. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  18. 18. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  19. 19. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  20. 20. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  21. 21. Radial lounge: the perfect combination for uncomplicated PCI AIM RADIAL 2013
  22. 22. Radial lounge: the perfect combination for uncomplicated PCI “LEAN” Discard all waste Minimize effort Maximize efficiency and (patient-) benefit AIM RADIAL 2013
  23. 23. Radial lounge: the perfect combination for uncomplicated PCI “LEAN” Patient Femoral Radial Immobile Ambulant Supervised Free Hospitalization Day-care AIM RADIAL 2013
  24. 24. Radial lounge: the perfect combination for uncomplicated PCI “LEAN” Organization Doctor Nurse practioner Nurse Host(ess) Host(ess) Partner/Family AIM RADIAL 2013
  25. 25. Radial lounge: the perfect combination for uncomplicated PCI “LEAN” Organization Central administrative work, not in lounge Patient welcomed by host(ess) Management by NP Information, preparation by NP and cathlab staff One partner per patient AIM RADIAL 2013
  26. 26. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  27. 27. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  28. 28. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  29. 29. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  30. 30. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  31. 31. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  32. 32. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  33. 33. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r AIM RADIAL 2013
  34. 34. Radial lounge: the perfect combination for uncomplicated PCI a e Y 1 r Lounge admissions From 1695 loungepatients 258 patients were transferred (15%) 1437 were discharged (85%) AIM RADIAL 2013
  35. 35. Radial lounge: the perfect combination for uncomplicated PCI Post discharge events in first 3 months PCI patients only N=297 van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  36. 36. Radial lounge: the perfect combination for uncomplicated PCI Baseline characteristics (N=297) N Male 219 Age 65±11 Alone 60 AP 0- I % 74.7 N % Prev. CABG 33 11.1 Prev. MI 76 25.6 20.2 1VD 128 43.0 10 3.3 2VD 112 37.7 AP II 229 77.1 3VD 57 19.2 AP III 42 14.1 Aspirin 261 87.9 AP IV 16 5.4 Clopidogrel 151 50.8 Prev. PCI 108 36.3 Coumadin 28 9.4 van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  37. 37. Radial lounge: the perfect combination for uncomplicated PCI Procedural data (N=297) N % N % RRA 259 87.2 CTO 34 11.4 LRA 31 10.4 Stents 1.6 0-5 5F 52 17.5 Success 284 95.7 6F 243 81.8 Partial 6 2.0 7F 2 0.7 Failure 7 2.3 1 vessel PCI 243 81.8 Dissection B 12 4.0 2 vessel PCI 53 17.8 Perforation 2 0.7 3 vessel PCI 1 0.3 Angioseal 1 0.3 van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  38. 38. Radial lounge: the perfect combination for uncomplicated PCI Lounge stay of 297 patients n % Uncomplicated 279 94.0 Access bleeding 14 4.7 13 1 4.3 0.4 4 1.3 Subcutaneous bleeding Bleeding after TR-band Angina van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  39. 39. Radial lounge: the perfect combination for uncomplicated PCI Telephone follow-up • Complaints within 48 hours? • Type of onset? • Which action? • Result? • Need for medical assistance? van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  40. 40. Radial lounge: the perfect combination for uncomplicated PCI Telephone follow-up N=297 n % Follow-up obtained Lost from follow-up 295 2 99.3 0.7 Medical assistance 12 4.0 van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  41. 41. Radial lounge: the perfect combination for uncomplicated PCI Telephone follow-up N=295 Medical assistance n=12 (4%) Allergic reaction Subcut. bleeding Rectal bleeding Chest pain Gastro-enteritis Atypical pains (arm, jaw) van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. n 4 2 1 1 1 3 % 1.3 0.6 0.3 0.3 0.3 1.0 AIM RADIAL 2013
  42. 42. Radial lounge: the perfect combination for uncomplicated PCI Telephone follow-up N=295 Medical assistance n=12 (4%) n MACE Major bleeding Readmission (uneventful) van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. % 0 0 1 0.3 AIM RADIAL 2013
  43. 43. Radial lounge: the perfect combination for uncomplicated PCI Conclusion •No major events post lounge-stay •Post discharge complaints were mild •Telephone follow-up is useful van Dullemen A. Short Stay is safe. Cordiaal 32[3], 76-80. 2011. AIM RADIAL 2013
  44. 44. Radial lounge: the perfect combination for uncomplicated PCI RADITIME: Shortening day care Purpose: Can we shorten discharge time after uneventful TRI from 6 to 4 hours post PCI. Prospective study in 100 patients from February to June 2012 Endpoint: 1.Complications post discharge 2.Need for medical assistance post discharge van Duinen, M. Raditime. Nursing Essay Price 2012. AIM RADIAL 2013
  45. 45. Radial lounge: the perfect combination for uncomplicated PCI RADITIME: Shortening day care van Duinen, M. Raditime. Nursing Essay Price 2012. AIM RADIAL 2013
  46. 46. Radial lounge: the perfect combination for uncomplicated PCI RADITIME: Shortening day care van Duinen, M. Raditime. Nursing Essay Price 2012. AIM RADIAL 2013
  47. 47. Radial lounge: the perfect combination for uncomplicated PCI RADITIME: Shortening day care Complaints(N=79) 4% 24% 15% 18% None Hematoma 39% Pain arm Pain chest Other van Duinen, M. Raditime. Nursing Essay Price 2012. AIM RADIAL 2013
  48. 48. Radial lounge: the perfect combination for uncomplicated PCI RADITIME: Shortening day care Follow up 79 pts after early discharge Medical assistance 3 (3.8%) MACE 0 Major bleeding 0 van Duinen, M. Raditime. Nursing Essay Price 2012. AIM RADIAL 2013
  49. 49. Radial lounge: the perfect combination for uncomplicated PCI Conclusion (1) TRI allows to re-engineer the process of hospitalization of PCI patients This lounge-like environment for ambulant and independent patients is the most extreme logistic manifestation of TRI and is the leanest, most efficient and most patient-friendly way of working AIM RADIAL 2013
  50. 50. Radial lounge: the perfect combination for uncomplicated PCI Conclusion (2) This concept allows a larger number of patients to pass your ward, allowing higher volume without increasing beds Our selection criteria for outpatient PCI are valid Outpatient PCI (4 hrs) is safe AIM RADIAL 2013

×