Date of Award

2025

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Bonnie Bowie

Readers

Terry Song

Abstract

Local Problem: Trans-femoral Access (TFA) has traditionally been the preferred route for coronary angiography (CA) due to ease of use. However, TFA is associated with complications, extended hospital stays, and increased costs. A quality improvement (QI) project was launched in May 2021 to promote Trans-radial Access (TRA) and same-day discharge (SDD) for elective CA procedures, aiming to reduce complications and improve patient outcomes.

Purpose: The purpose of this QI project was to compare and contrast patient outcomes and length of stays for patients undergoing elective coronary angiography (CA) utilizing Trans-radial Access (TRA) versus Transfemoral Access (TFA).

Methods: A retrospective chart review of 100 patients’ charts from the Interventional Radiology Department was conducted, dividing them into pre-intervention (n=50, July 2020-April 2021) and post-intervention (n=50, November 2023-June 2024) cohorts. Inclusion criteria consisted of elective percutaneous coronary intervention (PCI) cases on adult patients (ages 18-99 years), excluding emergencies, CABG history, and other specific conditions such as the presence of AV fistula or previous surgical interventions to the extremity. The review compared TRA and TFA groups for bleeding complications, access site, and length of hospital stay, with cost data obtained from the American PCI-registry and Medicare claims reports.

Results: The results showed significant improvements in outcomes associated with Trans-radial Access (TRA) for coronary angiography (CA). TRA usage increased by 34 percentage points, from 52% to 86%, between the pre-intervention and post-intervention cohorts. Hospital stays decreased for TRA patients, with a mean hospital stay of 0.54 nights compared to femoral access 1.76 nights (p < 0.05). Bleeding complications were lower in the post-intervention cohort, including hematoma rates with TRA (1 case in Cohort 2) compared to TFA (2 cases in Cohort 1). A cost analysis revealed lower average costs for same-day discharge ($13,322.50) compared to next-day discharge ($16,914.50). Overall, the QI project demonstrated improved outcomes and cost savings associated with increased TRA usage for CA.

Conclusion: Use of Trans-radial Access (TRA) for elective coronary angiography procedures can enhance patient outcomes and improve hospital efficiency.

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