Meeting the Triple Aim by switching from femoral to radial access

Although 90-95 percent of cardiac catheterizations in the U.S. are performed through the femoral artery, but radial access has been found to be a safer, faster, more comfortable, and more cost-efficient approach. Because the large femoral artery is accessed through the groin, while the radial artery is much smaller and accessed through the wrist, femoral access is a more invasive procedure with higher risks and adverse consequences.

Related: What is a Cardiovascular Information System (CVIS)

Here are some of the reasons why providers should consider switching to radial access in their quest for the Triple Aim—better patient satisfaction, improved care, and lower costs.

1. Lower Risk of Bleeding ComplicationsSince the femoral artery is adjacent to the abdominal cavity, an inadvertent puncture through the femoral artery can lead to blood loss in the retroperitoneal cavity behind the abdomen . Due to the large size of this cavity, at least one person in every large American city dies from bleeding in this space every year. Meanwhile, radial access presents no such blood loss risk because the radial artery can be compressed with a finger.
   In an analysis of 24 studies across the entire spectrum of patients with coronary artery disease (CAD), radial access was associated with a significantly lower risk for all-cause mortality when compared to femoral access. Radial access was shown to be safer, with reductions in major bleeding and vascular complications across the whole spectrum of patients with CAD.
2. Faster Recovery and Shorter Hospital StayPatients who have undergone transradial catheterization are able to sit up, walk, and eat immediately following the procedure, while femoral catheterization patients must lie flat for two to six hours to prevent bleeding. The shorter recovery time associated with radial access translates into shorter hospital stays and increased patient comfort, as radial access patients can be discharged the same day, even after stenting procedures.
   In the cath lab at Medical College of Georgia, Augusta University, Dr. Deepak Kapoor was an early adopter of the radial method. There they found that nearly 56 percent of outpatient percutaneous coronary interventions (PCIs) done radially were discharged on the same day. Even in complex cases, patients left the hospital with the assurance that they would not have significant bleeding issues since the radial approach eliminates complications such as retroperitoneal bleeds.
3. Increased Patient SatisfactionDue to shorter recovery times and hospital stays, Dr. Kapoor and others have observed increasing satisfaction among radial patients with a prior non-radial PCI. In a study comparing transfemoral catheterization to transradial, radial access was strongly preferred by patients because radial patients experienced less pain and greater walking ability post-procedure than femoral patients.
4. Lower CostAccording to the American Heart Association, cost savings related to radial access are mainly derived from lower vascular and bleeding complication rates, shorter average intensive care unit and hospital lengths of stay, and minor differences in procedure costs. An analysis of a large national administrative hospital database showed that the use of transradial access in PCI decreased overall costs by $533, with a $1,621 cost savings through transradial access in patients with high predicted bleeding risk. Multiplied by the number of procedures done annually, the cost savings are significant.
   Furthermore, a recent study of patients undergoing PCI for stable and unstable coronary artery disease in the National Cardiovascular Data Registry revealed an adjusted cost difference of $916 with transradial access compared to transfemoral access. In a cost-benefit analysis of radial access for coronary angiography and intervention, the radial approach saved $275 in direct hospital costs per patient when compared with the femoral approach.

Measuring and tracking your radial vs. femoral access with analytics is the first step toward changing physician behavior. Read this white paper for more about how this works and other ways to improve quality and increase margins in your cardiovascular service line.