Expanding availability of elective, non-emergent cardiac catheterization services to Saturdays might significantly reduce length of stay, with no effect on clinical quality reports a recent economic impact study.
The study, published online in the American Journal of Managed Care found that reduced length of stay did not result in total cost savings, however.
In January 2009, Mayo Clinic Rochester expanded cardiac catheterization service availability (CSA) to Saturdays with the "goal of timely access with improved efficiency of care," write the authors.
Despite succeeding in greatly reducing length of stay—a statistically significant, adjusted average of 1.73 days—total costs of care were similar prior to CSA expansion.
A study published in March of last year suggested that early invasive intervention—made possible by expanding cardiac catheterization to the weekend—produced a statistically significant savings of $2,938 per patient, mostly due to a reduction in length of stay.
In Mayo Clinic Rochester's case, however, an increase in percutaneous coronary intervention (PCI) created offsetting costs that diminished the cost-savings impact of a significantly reduced length of stay.
Despite the wash in total costs, the authors find the economic impact of Saturday service expansion to be positive. "Overall, we believe these results are indicative of higher-value care," they write.
But they leave a caveat for lower-volume centers: "Whether these favorable outcomes could be replicated in lower-volume centers with less support staff cannot be inferred from our data."
Is there a "weekend effect" in the cath lab?
And why did "a significantly higher proportion of patients" undergo PCI after expanded CSA? "Anecdotally, clinicians and operators favored more urgent patients for the limited Saturday cath procedures on clinical grounds," write the authors.
With more urgent patients scheduled for Saturday, one might also expect to see worse clinical outcomes on Saturdays due to a selection bias towards high risk cases, but no—"Clinical outcomes remained similar," write the authors.
"Our observations confirm the safety of this practice, at least in the environment in which it was tested," write the authors, responding to studies that suggest weekend admissions may correlate with increased risk of adverse events—what is known as the "weekend effect."
As more evidence emerges about the economic benefits of weekend catheterization services, you may soon be in for weekend shifts, if not already.
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