Reducing Readmissions After Transcatheter Aortic Valve Replacement Through Enhanced Transitional Care.

BACKGROUND

Transcatheter aortic valve replacement (TAVR) volumes continue to expand, increasing the need for optimized periprocedural and transitional care. Readmissions have substantial clinical and financial impact.

PROJECT RATIONALE: In 2018-2019, Lake Charles Memorial Hospital's 30-day post-TAVR readmission rate was 12.7%, with 58% unrelated to valve complications, prompting a quality-improvement initiative.

PROJECT SUMMARY: A phased, multidisciplinary pathway incorporated standardized discharge education, early follow-up, conduction system disease monitoring, social determinants of health screening with tailored resources provided, and home monitoring for high-risk patients. Guided by Plan-Do-Study-Act cycles, interventions emphasized patient engagement, proactive complication detection, and continuity of care. Post implementation (2022-2025 Q2), readmissions declined to 1.9% despite a higher-risk cohort, with concurrent reductions in length of stay and substantial cost savings.

TAKE-HOME MESSAGES: Structured, multidisciplinary transitional care can markedly reduce post-TAVR readmissions. Long-term sustainability is supported through patient-centered strategies and integration of social determinants of health-focused interventions.