(P213) EARLY RECOVERY AFTER TRANSCATHETER AORTIC VALVE INTERVENTION: A CLINICAL PATHWAY FOR NURSE SUPPORTED SEDATION AND SAFE SAME DAY DISCHARGE

Background: Transcatheter Aortic Valve Implantation (TAVI) has evolved to a highly predictable, relatively low-risk procedure today with favorable outcomes. Indication for TAVI has broadened the treatable AS population, increasing demand for TAVI procedures and surpassing volumes of surgical aortic valve replacements. Coupled with the constrained resources in staffing and catheterization room availability, timely access to care is challenged. Specifically, with limited anesthesia resources to support additional TAVI procedures in the Vancouver program, we strategized to streamline TAVI care whist maintaining safety. The critically trained catheterization lab nurse role within the TAVI procedure was extended to full scope of practice. The Early Recovery after TAVI (ERT) clinical pathway was developed to support the continuing of TAVI procedures without anesthesia services present through a physician led, nurse supported sedation model. Since data on nurse supported TAVI procedures is limited, we conducted a quality improvement study.

METHODS AND RESULTS: Patients that met ERT eligibility were prospectively enrolled. Elements of the ERT clinical pathway included protocols for the pre-, peri-, and post-procedural nursing care and criteria-driven same day discharge home. Utilizing quality improvement methodology of PDSA (Plan-Do-Study-Act) cycles, we evaluated changes iteratively with multiple stakeholders including participating patients. A total of 39 cases underwent ERT clinical pathway with same day discharge between October 2022 to April 2024 with a mean age 79 ± 5.6 years. 31 patients (79%) were male. 29 (74%) patients received no unplanned intravenous medications. There were no conversions to general anaesthesia for any cases and no procedural or in hospital mortality events. 37 (92.5 %) were discharged within the same day of procedure. One patient (2%) was readmitted a day after the procedure. Majority of the interviewed patients reported that the nurse supported sedation experience was positive.

Conclusion: The ERT clinical pathway has facilitated increased access to TAVI procedures at our site. Implications include the importance of a dedicated nurse for patient monitoring, the need for transparent and consistent communication between team members throughout the procedure and ensuring the patient as an active contributing member of the team. Refinement of the ERT clinical pathway is ongoing as we continue to track outcomes and the patient experience. The ERT clinical pathway may be generalizable to other centers with similar barriers to TAVI access to care. We plan to translate the learnings from this initiative into a multi-site research study to examine the feasibility and safety of the ERT clinical pathway.