title: Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common, growing, and costly medical condition. We aimed to evaluate the impact of a management algorithm for symptomatic AF that used an emergency department observation unit on hospital admission rates and patient outcomes.
  
  
  RESULTS
  This retrospective cohort study compared 563 patients who presented consecutively in the year after implementation of the algorithm, from July 2013 through June 2014 (intervention group), with 627 patients in a historical cohort (preintervention group) who presented consecutively from July 2011 through June 2012. All patients who consented to have their records used for chart review were included if they had a primary final emergency department diagnosis of AF. We observed no significant differences in age, sex, vital signs, body mass index, or CHADS2 (congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke or transient ischemic attack) score between the preintervention and intervention groups. The rate of inpatient admission was significantly lower in the intervention group (from 45% to 36%; P<0.001). The groups were not significantly different with regard to rates of return emergency department visits (19% versus 17%; P=0.48), hospitalization (18% versus 16%; P=0.22), or adverse events (2% versus 2%; P=0.95) within 30 days. Emergency department observation unit admissions were 40% (P<0.001) less costly than inpatient hospital admissions of ≤1 day's duration.
  
  
  CONCLUSIONS
  Implementation of an emergency department observation unit AF algorithm was associated with significantly decreased hospital admissions without increasing the rates of return emergency department visits, hospitalization, or adverse events within 30 days.
authors: Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
authors: Shawna D
authors: SD
authors: Bellew
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Merri L
authors: ML
authors: Bremer
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Stephen L
authors: SL
authors: Kopecky
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors: Christine M
authors: CM
authors: Lohse
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Thomas M
authors: TM
authors: Munger
authors: Department of Family Medicine, Mayo Clinic, Rochester, MN.
authors: Paul M
authors: PM
authors: Robelia
authors: Department of Emergency Medicine, Mayo Clinic, Rochester, MN smars.peter@mayo.edu.
authors: Peter A
authors: PA
authors: Smars
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration*; D003661:Decision Support Techniques; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004554:Electric Countershock; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration; D010359:Patient Readmission; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: anticoagulants; arrhythmia; fibrillation