Abstract
Study Objective: To determine whether a new emergency department short-stay unit (EDSSU) was an effective alternative to conventional hospital units (HU) for acute exacerbation of chronic heart failure patients. Methods: Design: A comparative analysis was used to identify differences among patients admitted to EDSSU (n = 1546) and those admitted to the internal medicine (n = 552) or cardiology wards (n = 336) during the period of the study (January 1, 2008 to December 31, 2012). Setting: The study was performed at Sant Pau Hospital, a 500-bed teaching tertiary care referral center in Barcelona, Spain. The ED attends about 144,000 emergency visits per year. Participants: We studied retrospectively the characteristics of patients hospitalized with an acute exacerbation of chronic heart failure between January 1, 2008 and December 31, 2012 (n = 2434). We chose charts of patients from the hospital discharge database and selected according to the 9th revision of the International Classification of Diseases Codes. We used the computerized database to obtain outcome data on all patients. Results: Statistically significant differences were found in terms of mean age (HU: 77.38 (14.44) years versus EDSSU: 82.43 (8.72) years; p < 0.001), mean length of stay (HU: 11.57 (10.42) days versus EDSSU: 4.75 (3.18) days; p < 0.001), mortality (HU: 14.0% versus EDSSU: 4.0%; p < 0.001), but not for urgent readmission rate of 30 days or less (HU: 18.30% versus EDSSU: 18.30%; p = 0.998). There were statistically significant differences regarding sex (HU women = 60.6%; EDDSU women = 67.7%; p < 0.001) and number of associated conditions (Charlson index HU = 1.25, EDDSU = 0.90; p < 0.001). Conclusion: The EDSSU proved to be an effective and safe measure in emergency care of patients with acute heart failure (AHF).
Highlights
Observation and short-stay units are becoming common in hospitals and are an increasingly important component of the modern emergency department (ED) because they are an alternative to admission or discharge
Treatment of selected patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) in an ED diagnostic and treatment unit rather than the inpatient ward results in the safe discharge of most such patients and the reduction in their hospitalization rate [8]
The objectives of the present study were to determine whether the introduction of an ED short-stay unit (EDSSU) would be an effective and safe alternative setting to standard hospital units (HU) for the management of acute heart failure (AHF)
Summary
Observation and short-stay units are becoming common in hospitals and are an increasingly important component of the modern emergency department (ED) because they are an alternative to admission or discharge. The criteria for admission to an ED short-stay unit (EDSSU) should be consistent with four principles: first, clearly identified patient care goals; second, limited need for intense medical services; third, limited severity of illness; and fourth, the patient should have a clinical condition that is appropriate for observation. The concept and goal of an EDSSU is to develop rapid diagnostic and treatment protocols that will avoid inpatient admissions for a variety of reversible acute medical conditions [1]-[7]. The development of ED chest pain evaluation units allows the rapid evaluation and treatment of patients with suspected acute coronary syndrome without hospitalization. Some authors have reported a higher level of patient satisfaction with an ED asthma observation unit than with routine inpatient hospitalization [9]
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