(CCCNP001) EARLY NURSE-LED EDUCATION FOR SAME-DAY DISCHARGE AFTER ATRIAL FIBRILLATION ABLATION: A PILOT STUDY

Background: Same-day discharge after atrial fibrillation (AF) ablation is increasingly employed, in response to limited hospital resources, bed capacity and evidence demonstrating feasibility and safety. Our same-day discharge protocol includes care in a multi-disciplinary AF Clinic with a pharmacist-led telehealth at 10 days and Nurse Practitioner (NP) visit at 3-months. Our centre recently reported >90% same-day discharge, but showed higher than anticipated emergency room (ER) visits post-ablation. Targeted support and education provided in the early post-ablation period could mitigate potentially unnecessary encounters with hospital care-providers. This project evaluated the feasibility and efficacy of early nurse-led follow-up and education after AF ablation.

METHODS AND RESULTS: Patients undergoing AF ablation with same-day discharge between July and September 2022 received a phone call by an AF Clinic nurse the day after the procedure. Participants completed a satisfaction survey 1-month post-procedure. Readmission and ER visits within 30 days after ablation were compared between participants in the pilot project and controls receiving usual care in the period prior to implementation.
Of the 50 participants (median age 65, 36% female) in the cohort, radiofrequency energy was used in 46 (92%) cases with no immediate peri-procedural complications. Median duration of the nurse-led phone-call was 13 minutes (range 4-86) and referral for urgent, additional follow-up was required for 9 (18%), including complaints of chest pain 4/9 (45%), arrhythmias 1/9 (11%), medication adjustment 2/9 (22%), groin site concerns 1/9 (11%), and other 1/9 (11%). The number of patients referred for urgent care decreased over the duration, indicating a learning curve for the nurses involved. Participants who completed the satisfaction survey (46, 92%) reported being satisfied with the education provided for post-procedure care, 32(70%) felt the follow-up call positively prevented them from seeking unnecessary medical attention and 44 (96%) reported improved patient care with the nurse-led phone call on day-1. Analysis showed ablation related hospital readmission in 2 (4 %) and ER visits in 9 (18 %) compared to 9 (18%) ER visits and zero hospitalizations in the usual care cohort of patients.

Conclusion: Although no significant reduction in 30-day readmission or ER visits was observed with early nurse-led contact after AF ablation, this pilot demonstrated feasibility of nurse-led day-1 phone call and good patient reported satisfaction. We also observed a learning curve for nurses, with decreasing rates of referral for urgent post-procedure care. Larger studies are warranted to explore true efficacy of a nurse-led phone-call day-1 after AF ablation.