Background: Clinical researchers are major actors in translating evidence-based medicine into the care of
patients. Acute Coronary Syndrome (ACS) is a good example for the implementation of complex intervention in the
current context of growing economic pressure. According to the 2012 European Society of Cardiology guidelines,
early discharge (approximately 72 hours of hospitalization) is reasonable in selected low-risk patients hospitalized with
STEMI (ST-elevation myocardial infarction), if early rehabilitation is arranged. However, early discharge is not widely
applied in clinical practice, and the potential barriers to shorten LOS have not been studied for patients hospitalized
with an ACS.
Method: We will prospectively enroll 200 patients hospitalized with an ACS at the Geneva University Hospital
using a before (100 patients, 2012-2013) and after (100 patients, 2013-2014) prospective cohort design. We will
implement a systematic intervention consisting of four steps: (1) identification of low-risk patients treated successfully
with percutaneous intervention using the Zwolle index Score; (2) targeting promptly an early discharge date within 72
hours after admission; (3) definition of a standard process of care during the hospital stay and (4) referral to a cardiac
rehabilitation program within 10 days.
As primary outcome, we will assess the evolution of LOS using administrative data.
As secondary outcomes, we will analyze the potential barriers to an early discharge, the indicators of quality of
care and the cost benefits comparing both periods before and after the implementation of an early discharge strategy.
We will also assess the safety with a phone call at 30-day.
Summary: In the area of increase concerns on the long-term sustainability of the current health system,
translational science focusing on clinical effectiveness is more than needed. The systematic application of evidencebased
recommendation is a way to improve the efficiency of process of care, as well as the transition from inpatient
to outpatient setting.