Learning from changes implemented during the COVID pandemic to improve an atrial fibrillation ablation service

We conducted a service evaluation project of all atrial fibrillation (AF) ablation cases encompassing the period 2015-2023 at our tertiary National Health Service (NHS) trust. During this time period the World was affected by the COVID pandemic and the associated challenges this created for service delivery and clinical practice. System adaptations during the pandemic have effectively remodelled the service to improve healthcare utilisation in a stretched NHS setting.

During the pandemic our elective ablation patients were recovered on our theatre admissions day care unit rather than on an inpatient ward or cardiac catheter suite recovery area. This change came about due to bed pressures and strict protocols brought about by the pandemic. This unit is a dedicated elective pre-procedural and recovery unit staffed to open 7AM-10PM. We have continued to utilise this service post-pandemic and we aimed to assess the impact this had on our service delivery.

Our service review was conducted using our Infoflex database for all AF ablation procedures between January 2015- December 2023. The data was then analysed after being exported into a Microsoft Excel spreadsheet by a group of clinicians. We analysed multiple clinical and systemic parameters over the whole review period and also year to year. These included ablation energy, re-do ablation rate, anaesthetic use, same day discharge and readmission (within 48 hours) following same day discharge

1173 AF ablation procedures were performed on 961 patients during the review period. Cryoablation (Cryo) accounted for 56.18%, 43.14% Radiofrequency (RF). Re-Do ablation was carried out in 192 patients (19.98%). 542 procedures (46.21%) were conducted under General Anaesthetic, 82.2% being RF procedures. For evaluation purposes we considered pre-pandemic (2015-2019) and post pandemic (2022-2023) periods. Between 2015-2019, 720 procedures were performed (389 Cryo, 326 RF, 5 abandoned). 283 procedures were performed between 2022-2023 (171 Cryo, 110 RF, 2 abandoned). Same day discharge was achieved in 16.31% of procedures (24.15% Cryo, 6.39% RF) 2015-2019. In 2022-2023 this had increased to 48.14% (62.88% Cryo, 28.18% RF), p=<0.05. This translated to an average of 45 fewer overnight stays per year. Readmission within 48 hours of same day discharge occurred in 1 patient 2015-2019, 3 patients readmitted 2022-2023.

The COVID pandemic had a significant impact on working practices, especially elective activity and waiting list increases. Our experience has shown that positive changes have also been brought about. Continued use of pathways developed during the pandemic has seen significant improvements in same day discharge rates within our service at no significant readmission cost. This increase has saving implications financially as well as improving emergency bed availability by reducing elective bed requirements.

Graph showing patient discharge outcomes