Background: Aortic stenosis is a common disease that affects older adults. With an expanded indication, low-risk patients can now be offered the option of TAVR. Hospitals will need to effectively and efficiently accommodate the expected increase in demand for the TAVR procedure without compromising patient outcomes. Objective: The purpose of this study was to evaluate the development of a post-transcatheter aortic valve replacement protocol to standardize care and progress the patient from the operating room to discharge. Methods: We used a prospective pre-post design to evaluate the effect of education and a technology-supported intervention on length of stay, quality of life (measured by the Kansas City Cardiomyopathy Questionnaire; KCCQ12), and early mobility in TAVR patients between April 2019 and March 2020. Interventions: Two components of the intervention included team-based education and integration of guideline-based orders in the electronic record (EHR). Education regarding expectations for early mobilization and discharge plan was provided to patient and staff to ensure a timely discharge home. Results: Overall and post-procedural length of stay were significantly improved (5.26 days vs 2.45; p<0.001 and 3.05 days vs 2.16 days; p<0.004) respectively. Quality of life improved in both groups from baseline to 30 day follow up (p=0.012) No significant difference was shown in the 5-meter walk test. Conclusion: These findings suggest that implementation of an evidence based EHR-embedded order set is associated with a significant improvement in overall and post-procedure length of stay at 6 moths and a significant improvement in post-procedure quality of life. Future work is needed to examine strategies to ensure safe next day discharge.
Background Aortic stenosis is prevalent among older adults and is commonly treated with transcatheter aortic valve replacement. Both high- and low-risk patients benefit from early mobility and discharge after this procedure; however, hospital protocols to improve patient mobility and shorten hospital stays have not been systematically implemented. Objective To develop and evaluate a post–transcatheter aortic valve replacement protocol to standardize care and efficiently advance patients from the operating room to discharge. Methods A prospective pre-post design was used to evaluate the effect of the new standardized protocol on length of stay, timing of mobility, time spent in intensive care, and quality of life in patients undergoing transcatheter aortic valve replacement between April 2019 and March 2020. Interventions Interventions included team-based education and integration of an evidence-based order set into the electronic health record. Education was provided to both patients and staff. Results At 6 months after implementation of the intervention, statistically significant improvements were observed in mean overall (5.26 vs 2.45 days; P = .001) and postprocedure (3.05 vs 2.16 days; P = .004) length of stay. No significant difference was found in performance on the 5-meter walk test. Quality of life improved in both groups from baseline to 30-day follow-up (P = .01). Conclusion Implementation of the post–transcatheter aortic valve replacement protocol was associated with significant improvement in overall and postprocedure length of stay and improved quality of life. Additional work is needed to examine strategies to ensure safe next-day discharge.
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