Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care.
OBJECTIVE
To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain.


METHODS
Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective.


METHODS
The emergency department at the Northern General Hospital, Sheffield, United Kingdom.


METHODS
972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance.


METHODS
The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service.


RESULTS
Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, -7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of pound 78 per patient (- pound 56 to pound 210, P = 0.252).


CONCLUSIONS
Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care.
Goodacre
Steve
S
School of Health and Related Research, University of Sheffield, Sheffield S1 4DA. s.goodacre@sheffield.ac.uk
Nicholl
Jon
J
Dixon
Simon
S
Cross
Elizabeth
E
Angelini
Karen
K
Arnold
Jane
J
Revill
Sue
S
Locker
Tom
T
Capewell
Simon J
SJ
Quinney
Deborah
D
Campbell
Stephen
S
Morris
Francis
F
D000465:Algorithms; D002637:Chest Pain / Q000191:economics / Q000628:therapy*; D016000:Cluster Analysis; D003327:Coronary Disease / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration; D004739:England; D006302:Health Services Research; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D018710:Pain Clinics / Q000191:economics* / Q000458:organization & administration; D019057:Quality-Adjusted Life Years