Emergency Department Observation of Heart Failure: Preliminary Analysis of Safety and Cost

Authors

  • Alan B. Storrow MD,

    1. From the Department of Emergency Medicine;1Department of Internal Medicine, Division of Cardiology;2 and Institute for Health Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
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  • 1 Sean P. Collins MD,

    1. From the Department of Emergency Medicine;1Department of Internal Medicine, Division of Cardiology;2 and Institute for Health Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
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  • 1 Michael S. Lyons MD,

    1. From the Department of Emergency Medicine;1Department of Internal Medicine, Division of Cardiology;2 and Institute for Health Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
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  • 1 Lynne E. Wagoner MD,

    1. From the Department of Emergency Medicine;1Department of Internal Medicine, Division of Cardiology;2 and Institute for Health Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
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  • 2 W. Brian Gibler MD,

    1. From the Department of Emergency Medicine;1Department of Internal Medicine, Division of Cardiology;2 and Institute for Health Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
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  • and 2 Christopher J. Lindsell PhD 1,3

    1. From the Department of Emergency Medicine;1Department of Internal Medicine, Division of Cardiology;2 and Institute for Health Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
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Alan B. Storrow, MD, Department of Emergency Medicine, 231 Albert Sabin Way, MSB # 6109, Cincinnati, OH 45267-0769
E-mail: alan.storrow@uc.edu

Abstract

Emergency-department (ED)-based observation-unit treatment has been shown to reduce inpatient admissions, hospital bed-hours, and costs without adversely affecting outcomes for several conditions. A sequential group design study compared risk-matched, acute decompensated heart failure patients admitted directly to the inpatient setting with those admitted to an ED observation unit for up to 23 hours before ED disposition. Outcomes were 30-day readmissions or repeat ED visits for heart failure or 30-day mortality. Estimates of bed-hours and charges between the groups were compared. Sixty-four patients were enrolled with 36 inpatient admissions and 28 observation unit patients. No patients died within 30 days. Observation unit patients had no significant difference in outcomes, a decrease in time from ED triage to discharge, a saving in mean bed-hours, and less total charges. This pilot trial provides preliminary data that suggest admitted, low-risk heart failure patients may be safely and cost-effectively managed in an ED-based observation unit. These findings need to be further evaluated in a randomized clinical trial.

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