Developing a Same-Day Discharge Clinical Pathway for Patients Undergoing Elective Percutaneous Coronary Intervention Using a Nominal Group Technique

Abstract

Same-day discharge (SDD) following elective percutaneous coronary intervention (PCI) has gained popularity; however, uptake varies worldwide, and existing SDD consensus documents have largely been developed without input from clinicians and consumers. We aimed to develop an SDD clinical pathway in collaboration with clinicians, patients, and carers. This was a mixed-methods study. The AGREE II instrument was used to guide the development of the SDD clinical pathway to ensure rigour. A hybrid workshop, allowing both online and in-person attendance, was conducted with participants from six public hospitals in Queensland, Australia. The project funded all participants' travel to the workshop to maximise in-person attendance. A modified seven-step nominal group technique was used to guide the workshop and refine the clinical pathway. Sessions in Step 4 (participants presented ideas one by one) and Step 5 (researchers provided clarification) were audio-recorded and transcribed verbatim. Deductive content analysis was undertaken. We counted and recorded numbers for quantitative data. A total of 15 participants took part in the study, including nurses (n=6), medical officers (n=5), patients (n=3), and a carer representative (n=1). Consensus was achieved for six out of seven pre-PCI factors, all 14 post-PCI factors, all nine pre-discharge checklist statements, and all five risk management statements. All participants agreed that, despite the consensus, the final SDD decision should remain with the interventional cardiologist performing the procedure. Our approach has demonstrated that the developed clinical pathway is not only evidence-based but also considers contextual factors and the needs of consumers. It will assist clinicians in making decisions about SDD in hospitals, thereby enhancing the efficiency of cardiac service delivery and improving patient satisfaction.