Abstract
Introduction Modern day catheterisation laboratories must cater both for elective outpatient cases and acute inpatient presentations. With the limited resources of our health system under significant strain in the setting of a global pandemic, economic factors must invariably be considered in order to provide adequate care to meet the requirements the largest possible proportion of our population. We sought to assess the impact on hospital costs and patient flow of opening a second laboratory (the ‘Acute Lab’) for acute inpatient cases at University Hospital Limerick, a nationally designated 24/7 primary percutaneous coronary intervention (PPCI) centre. Methods We carried out a single-centre retrospective analysis of inpatients who underwent procedures in the Acute Lab over a 12-week period from August-November 2020. The Acute Lab was open 3 days per week (Monday/Wednesday/Friday) from 08:00-13:00. Data collection included patient admission routes, wards/locations, referring diagnoses and procedural details, as well as hospital costs and number of admission days pre- and post-procedure [figure 1]. Cost estimates for inpatient stays and various procedures were gathered with input from the hospital finance department. Results 171 patients underwent procedures in the Acute Lab over our study period (mean of 4.75 cases/day). Mean age was 64.71 (± 13.09) years. 101 patients were male. The vast majority of patients were admitted via ED/AMU and were admitted under the cardiology or general medical services. 38.01% of patients were referred with acute coronary syndrome and 66.67% had positive cardiac biomarker (high sensitivity troponin). 21.64% of patients underwent PCI and 12.28% underwent permanent pacemaker implantation [figure 2]. 67.25% of patients were discharged either same-day (33.33%) or one day (33.92%) post-procedure [figure 3]. The additional cost of opening the second cath lab (primarily staffing costs encompassing nursing, physiologist, radiography and cleaning staff) was approximately €1626 per day (08:00-13:00 only), or €342 per patient (based on a mean of 4.75 cases/day). One hospital admission day to a general ward in UHL costs €890, with a CCU admission priced even higher. If each of the 115 patients who were discharged within 24 hours of their procedure needed just one further day of admission, this would cost the hospital an additional €63,020 (over 12 weeks), or €252,080 per annum. If the increased costs of CCU bed days and delays >24 hours were taken into account, this number would be expected to be higher again. The actual cost of each procedure was not included in this cost analysis as these fixed costs would be required irrespective of when the procedure was actually carried out. Abstract 60 Figure 1 Referring diagnosis [Figure omitted. See PDF] Abstract 60 Figure 2 Procedures [Figure omitted. See PDF] Abstract 60 Figure 3 Discharges [Figure omitted. See PDF] Conclusions The opening of a second cath lab in our tertiary centre helped to improve patient flow, reduce waiting times for procedures, reduce admission lengths and reduce cost to the hospital. These are all important factors as our health service struggles to come to terms with the economic and organisational impact of the COVID-19 pandemic.