title: A comparison trial for stratifying intermediate-risk chest pain: benefits of emergency department observation centers.
abstract: Chest pain of uncertain etiology (intermediate-risk chest pain [IR-CP]) constitutes a majority of acute chest pain presentations to emergency departments (EDs). A before- and-after trial of 2197 IR-CP patients transferred from the hospital's ED to one of three units-ED-based observation center (ED-OC), inpatient observation center (IN-OC), and inpatient units-compared mean cost, length of stay, and safety over a 2-year period. The mean per patient cost for management of IR-CP was lower in the ED-OC ($1642) than the IN-OC ($1910) or the inpatient units ($2785). The mean length of stay was shorter in the ED-OC (0.75 days) than in the IN-OC (1.18 days) or the inpatient units (2.16 days). Return rates were lower in the ED-OC at 7 days (0%) and at 6 months (0.45%) than the IN-OC (0% and 1.22%) or the inpatient units (0.77% and 3.67%). Overall hospital costs for managing IR-CP dropped significantly (12.5%) after the ED-OC was opened. ED-OCs provide a safe and cost-effective alternative to admission of IR-CP patients.
authors.affiliation: Department of Emergency Medicine, University of Texas Health Science Center-Houston, Houston, TX 77030, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Robinson
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Woods
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Snedeker
authors.forename: James H
authors.initials: JH
authors.lastname: Lynch
authors.forename: Kimberly
authors.initials: K
authors.lastname: Chambers
mesh_terms: D000704:Analysis of Variance; D002637:Chest Pain / Q000191:economics* / Q000209:etiology; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D006757:Hospital Units; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019370:Observation; D012449:Safety