607 - Feasibility and Safety of a Novel 72-Hour Emergency Department-to-Outpatient IR Pathway: A Single-Center Cohort Study

Purpose: Evaluate feasibility/safety of a novel 72-h ED→IR triage pathway that discharges ED pts home with scheduled outpatient IR to avoid admissions, decrease ED crowding, deliver value-based care, and optimize resource use.

Materials and Methods: Retrospective review, single academic center, 07/2024–07/2025; 2,430 IR cases screened. Excluded: neuro-IR (n=107), ordered as ER (526), performed more than 3 days from placing order (n=1,618), and patients without an ER visit (n=85). Included: ED pts needing an IR procedure, no admission indication, discharged and scheduled ≤72 h as an outpatient procedure (n=94). Procedures: central venous access 33%, hemodialysis-access interventions 29%, nephrostomies 15%, G/GJ tubes 12%, misc 11%. Primary endpoints: (1) pathway success (arrival + procedure as scheduled ≤72 h) and (2) technical success. Secondary: ED LOS, pre-IR bouncebacks/admissions, periprocedural complications, and post-IR morbidity/mortality through 60 d. EHR used for baseline acuity/comorbidities.

Results: Median age 57; 55% male; 40% uninsured. High acuity: ASA III 87%; CKD 71%; 22% anticoagulated. Median ED→IR 55 h; ED LOS 8 h. Pathway completion 97% (91/94). Intended procedure performed 99% (93/94); technical success 99% (93/94). Pre-IR bounceback 2% (2/94); no pre-IR deaths. Periprocedural complications 3% (3/94). Post-procedure, 38% (36/94) had any ED visit/admission within 30 d (median 13 d), of which 15% (14/94) were IR-related. ICU transfer ≤30 d: 0%. Mortality at 30 and 60 d: 1% each (1/94).

Conclusion: A 72-h ED→IR outpatient pathway is feasible/safe in a high-acuity cohort, reliably achieving technical success while obviating bridging admissions. Most post-procedure returns were non-IR-related, suggesting this model can reduce ED crowding without compromising short-term outcomes. Future studies should compare with conventional IR utilization and assess cost-effectiveness.