title: Emergency department observation of heart failure: preliminary analysis of safety and cost.
abstract: Emergency-department (ED)-based observation-unit treatment has been shown to reduce inpatient admissions, hospital bed-hours, and costs without adversely affecting outcomes for several conditions. A sequential group design study compared risk-matched, acute decompensated heart failure patients admitted directly to the inpatient setting with those admitted to an ED observation unit for up to 23 hours before ED disposition. Outcomes were 30-day readmissions or repeat ED visits for heart failure or 30-day mortality. Estimates of bed-hours and charges between the groups were compared. Sixty-four patients were enrolled with 36 inpatient admissions and 28 observation unit patients. No patients died within 30 days. Observation unit patients had no significant difference in outcomes, a decrease in time from ED triage to discharge, a saving in mean bed-hours, and less total charges. This pilot trial provides preliminary data that suggest admitted, low-risk heart failure patients may be safely and cost-effectively managed in an ED-based observation unit. These findings need to be further evaluated in a randomized clinical trial.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267-0769, USA. alan.storrow@uc.edu
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagoner
authors.forename: W Brian
authors.initials: WB
authors.lastname: Gibler
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D010343:Patient Admission; D010359:Patient Readmission; D010865:Pilot Projects; D018570:Risk Assessment; D012449:Safety; D013997:Time Factors