A trial of early discharge with homecare compared to conventional hospital care for patients undergoing coronary artery bypass grafting.

T he UK has one of the longest waiting lists for coronary artery bypass grafting (CABG). In 1999–2000, 24 798 CABG procedures were performed at a typical cost of £4956, leading to total direct costs in excess of £122 million. Early discharge programmes have been introduced as a strategy to reduce hospital costs, increase the throughput of patients and decrease waiting list times. Early studies have reported reductions in hospital length of stay (LOS) and hospital costs, without an increase in complication rates. There are concerns that early discharge programmes may increase morbidity after discharge and increase the demand on community health care resources, simply moving costs downstream without any true overall savings. The Royal Brompton Hospital has introduced a new early discharge programme that contained enhanced preoperative preparation, planned early discharge, and specialist homecare. We report the results of a randomised trial to compare costs, clinical outcomes, and quality of life in an early discharge homecare programme compared to conventional hospital care.