Day case complex devices: the state of the UK

• Published in: Open heart 2019-01, Vol.6 (1), p.e001023
• Main Authors: Waight, Michael, Elawady, Abdula, Gage, Heather, Touray, Morro, Adhya, Shaumik
• Format: Article
• Language: English
• Subjects: Audits; cardiology; Clinical medicine; complex cardiac devices; Cost analysis; Cost control; day case procedures; Defibrillators; Health Care Delivery, Economics and Global Health Care; hospital economics; Joint surgery; Patient satisfaction; Studies
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2019-001023

ObjectiveComplex cardiac devices including implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices can safely be implanted as a day case procedure as opposed to overnight stay. We assess how common day case complex device therapy is and the cost implications of more widespread adoption across the UK.MethodsA freedom of information request was sent to all centres performing complex cardiac devices across the UK to assess the adoption of this technique. Cost implications were assessed using Department of Health National Schedule of Reference Costs 2016–2017.Results100 UK centres were surveyed, 80% replied. Eighty per cent of UK centres already implant complex cardiac devices as a day case to some extent. 64.06% of centres have a protocol for this. 12.82% of centres do 75% as day case. There was no relationship between centre volume and the proportion of devices done as a day case as opposed to overnight stay. The cost saving of performing a complex device as a day case as opposed to overnight stay was £412 per ICD, £525 per CRT-pacemaker and £2169 per CRT-defibrillator.ConclusionsDay case complex devices are already widespread across the UK, however, there is scope for increase. An increase in proportion of day case devices could translate to £5 583 265 in savings annually for the National Health Service if all centres performed 75% of devices as a day case.