title: The effect of a short-stay unit on hospital admission and length of stay in acute heart failure: REDUCE-AHF study.
abstract: OBJECTIVE
  To determine whether the presence of a short-stay unit(SSU) in a hospital influences the percentage of admissions, length of hospital stay(LOS) and outcomes in emergency department(ED) patients with acute heart failure(AHF).
  
  
  METHODS
  Retrospective analysis of AHF patients presenting to one of 34 Spanish ED included in EAHFE registry. Baseline and ED data of patients were collected. Patients were classified into two groups in function of being attended at hospitals with or without a SSU. Main outcome variables were the percentage of admissions from ED, and LOS for admitted patients. Secondary variables were all-cause death and ED revisits for worsening heart failure within 30days following discharge.
  
  
  RESULTS
  Of 9078 patients presenting to the ED (SSU 5191; no SSU 3887), 6796 (74.8%) were admitted. Compared to hospitals without a SSU, the admission rate in hospitals with a SSU was 8.9% higher (95%CI 6.5%-11.4%), but 30-day ED revisit and mortality rates were lower among patients discharged directly from the ED (-10.3%, 95%CI -16,9% to -3.7%; and -10.0%, 95%CI -16.6 to -3.4%, respectively). For admitted patients, the overall LOS was 9.3±9.5days, being 2.2days shorter (95%CI -2.7 to -1.7) in hospitals with a SSU, with no significant differences in in-hospital, 30-day mortality or 30-day ED revisit rates.
  
  
  CONCLUSIONS
  The data suggest that SSU may improve the safety of emergency care of patients with AHF, but at the cost of a higher rate of hospital admissions, and it may also reduce the LOS for admitted patients without affecting post discharge safety.
authors.affiliation: Área de Urgencias, Hospital Clínic, Barcelona, Spain; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Servicio de Urgencias, Hospital Universitario Rio-Hortega, Valladolid, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Carbajosa
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Servicio de Urgencias, CortaEstancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Llorens
authors.affiliation: Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Herrero
authors.affiliation: Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.affiliation: Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
authors.forename: Antoni Juan
authors.initials: AJ
authors.lastname: Pastor
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos de Madrid, Spain. Electronic address: fjjms@hotmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
keywords: Acute heart failure; Emergency department; Length of stay; Management; Mortality; Revisit; Short-stay unit