Offering early treatment via weekend cath lab hours lowers costs

It may sound counterintuitive, but healthcare costs could be reduced by including weekend hours in the cardiac catheterization lab, according to a study published in the March issue of the Canadian Journal of Cardiology.

The initial study, Timing of Intervention in Acute Coronary Syndromes (TIMACS), looked at patient outcomes when treated for non-ST-segment elevated acute coronary syndromes (NSTEACS) by angiography and intervention within 24 hours (rapid or early treatment) or after 36 hours (delayed) in a global cohort of patients. Patients who were treated earlier, on the whole, did better, researchers found. However, one barrier to rapid treatment they noted was the availability of procedures at the cardiac cath lab on the weekends.

Andre Lamy, MD, MHSc, from the Population Health Research Institute at McMaster University in Hamilton, Ontario, and colleagues used the Canadian TIMACS population to determine what the direct costs were for early vs. delayed treatment. They also analyzed what the price would be for keeping the cath lab on call on the weekends.

Early intervention reduced costs for Canadian patients by $2,365 ($2,938 CAD). Shortened length of stay largely drove cost savings, they found, by approximately $2,260 ($2,808 CAD). Patients treated earlier had 2.3 fewer days in hospital. When they analyzed the whole TIMACS population, early intervention still saved $1,248 ($1,550 CAD) in total costs, despite regional differences.

After considering an increased cost for weekend work, savings were still significant for early intervention patients. If 5 percent of patients treated within 24 hours had been treated on the weekend, $2,326 ($2,889 CAD) would still have been saved, they wrote. The cost savings had 50 percent of patients been treated on the weekends would still have been $1,868 ($2,321 CAD).

These findings persisted throughout subgroup analysis.

An accompanying editorial by Stéphane Rinfret, MD, SM, from Quebec Heart and Lung Institute, and Brian J. Potter, MDCM, SM, from the Interventional Cardiology and Healthcare Services Research Centre Hospital at the University of Montreal, wrote that "While the evidence for cost savings utilizing an earlier catheterization strategy certainly appears robust, the authors' conclusions about the need to mobilize the CCL [cardiac catheterization lab] team during weekends for patients with NSTE-ACS merit further discussion." Their concerns surrounded whether or not actual practice was reflected by the original TIMACS study and if that would potentially alter costs in a real-world setting.

“Ultimately, any economic benefit (which remains an open question) of performing these cases must be weighed against its potential negative impact on already-stretched weekend call teams, including on morale, healthcare workers’ physical or mental health, and possibly and most importantly, patients’ safety,” they wrote.

However, Lamy et al contended that based on shortened hospital stays, weekend catheterization was cost efficient. They suggested that hospitals consider the option of weekend catheterization, even among stable patients, “as the savings from adhering to the timing of an early intervention approach would outweigh additional costs.”