title: Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care.
abstract: 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.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA. s.goodacre@sheffield.ac.uk
authors.forename: Steve
authors.initials: S
authors.lastname: Goodacre
authors.forename: Jon
authors.initials: J
authors.lastname: Nicholl
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cross
authors.forename: Karen
authors.initials: K
authors.lastname: Angelini
authors.forename: Jane
authors.initials: J
authors.lastname: Arnold
authors.forename: Sue
authors.initials: S
authors.lastname: Revill
authors.forename: Tom
authors.initials: T
authors.lastname: Locker
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Capewell
authors.forename: Deborah
authors.initials: D
authors.lastname: Quinney
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Francis
authors.initials: F
authors.lastname: Morris
mesh_terms: 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