How much care is enough?
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For years, patients undergoing elective PCI were routinely kept in hospital overnight.
If a patient is well enough to recover at home, should an overnight stay still be standard practice?
That question propelled clinicians and nurses at the National University Heart Centre, Singapore (NUHCS), to redesign care for selected patients undergoing elective PCI.
The results challenged assumptions
Since the PCI Same-Day Discharge programme became fully operational in 2024, 79 per cent of eligible PCI patients have been discharged on the same day. More than 300 hospital bed-days have also been saved for patients who require acute inpatient care.
Challenging a long-standing belief
Dr Gavin Ng, Senior Consultant, Department of Cardiology, NUHCS, said PCI was traditionally treated as a higher-risk procedure, making overnight observation standard practice.
But PCI care has evolved. Clinical studies and NUHCS’s local registry have shown that same-day discharge can be safe when patients are carefully selected.
The shift was not about keeping patients in hospital by default, but about providing them the care they needed — no more and no less.
A nurse-led redesign
Turning that evidence into practice required a redesigned workflow. Ms Yap El Fuon, Assistant Nurse Clinician, and her team introduced a structured same-day discharge pathway that begins from admission.
Nurses assess patients on admission, immediately after the procedure and before discharge. They check readiness criteria such as stable vital signs, adequate pain control, safe mobilisation, wound condition, medication supply, follow-up appointments and discharge instructions for patients and caregivers.
Ms Yap said the programme strengthened multidisciplinary collaboration, with teams working towards a shared discharge goal from the outset.
The pathway depends as much on preparation as on clinical assessment. Before discharge, patients and caregivers are taught about medication, wound care, lifestyle changes, warning signs, emergency response plans and whom to contact for support.
While some patients were initially uncertain when told they could go home on the same day, clear explanations and structured education often reassured them and built their confidence to recover at home.
The programme reinforced a simple lesson: longer care is not always better care.
For suitable patients, the focus shifted to the right care, at the right time, in the right setting. Same-day discharge reduced unnecessary hospitalisation while maintaining safety, freeing beds for patients who would benefit most from acute inpatient care.
For patients, going home earlier means more than leaving hospital sooner. It means sleeping in their own bed, being with family and returning to familiar routines.
Ms Yap observed that patients often recover more comfortably in familiar surroundings, while families are involved earlier in the process. The support remains; only the setting changes.
So, is an overnight stay always necessary?
For suitable patients undergoing PCI, the answer is no.
The NUHCS experience showed that recovery at home can be as safe as recovery in hospital when patients are carefully selected, well prepared and closely supported.
It also showed how nurses and clinicians can challenge assumptions and redesign care around what patients truly need.
Because value is not measured by how long a patient stays in hospital, but by whether the patient recovers safely, confidently and with as little disruption as possible to their lives.
Appropriate and Value-Based CareAppropriate and Value-Based Care (AVBC) starts with a simple question: what outcomes matter most to patients? By measuring outcomes and learning from variation, clinicians can identify what works, redesign care pathways and continually improve care. The goal is not simply to do more, or spend less. It is to deliver better outcomes for patients while making the best use of healthcare resources. |
In consultation with Dr Gavin Ng, Senior Consultant, Department of Cardiology, NUHCS and Assistant Professor, NUS Yong Loo Lin School of Medicine (NUS Medicine); and Ms Yap El Fuon, Assistant Nurse Clinician, NUHCS.
