Only modest resources are needed to improve treatment of hospitalised patients with chest pain or heart failure: rapid assessment is a safe and efficient strategy.
BACKGROUND
The objective of this study was to evaluate the safety and efficacy of rapid assessment using modest resources in hospitalised chest pain and heart failure patients.


METHODS
We evaluated 81 patients hospitalised for chest pain or heart failure in a prospective rapid assessment group and 162 patients in a retrospective usual care group with 6 months' follow-up. Main outcome measures were length of hospital stay at index observation, number of days spent in hospital for all causes, chest pain or heart failure, and number of visits to the doctor.


RESULTS
Chest pain patients: Length of hospital stay was significantly shorter in the rapid assessment group (1.3 vs. 3.7 days, P<0.0001). Days spent in hospital over 6 months were fewer in the rapid assessment group (2.9 vs. 8.8 days, P<0.005). Furthermore, the number of days spent in the hospital for chest pain or heart failure decreased (2.5 vs. 8.0 days, P<0.01). Heart failure patients: The length of hospital stay (8.7 vs. 9.7 days, P=ns) or days spent in the hospital over 6 months did not differ (25.7 vs. 23.1 days, P=ns). However, there were fewer days (10.5 vs. 16.7 days, P<0.01) spent in the hospital for chest pain or heart failure in the rapid assessment group.


CONCLUSIONS
Rapid assessment of hospitalised chest pain and heart failure patients on the next working day is a safe strategy in a medium-sized hospital. In 6 months, rapid assessment effectively reduces days spent in the hospital in chest pain patients, but not in heart failure patients. It can easily be integrated into standard care using modest resources.
Kosunen
Valtteri
V
Department of Internal Medicine, Helsinki University Central Hospital, Peijas Hospital, Sairaalakatu 1, Vantaa 01400, Finland. valtteri.kosunen@helsinki.fi
Lilleberg
Jyrki
J
Tiensuu
Tuomo
T
Sund
Reijo
R
Pohjola-Sintonen
Sinikka
S
D000368:Aged; D002637:Chest Pain / Q000175:diagnosis*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care