Emergency Department Observation of Heart Failure: Preliminary Analysis of Safety and Cost

Emergency-department (ED)-based observation-unit treatment has been shown to reduce inpatient admissions, hospital bedhours, and costs without adversely affecting outcomes for several conditions. A sequential group design study compared riskmatched, 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 bedhours, 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

Alan B. Storrow, MD;1 Sean P. Collins, MD;1 Michael S. Lyons, MD;1 Lynne E. Wagoner, MD;2 W. Brian Gibler, MD;2
Christopher J. Lindsell, PhD1,3
From the Department of Emergency Medicine;1 Department of Internal Medicine, Division of Cardiology;2 and Institute for Health
Policy and Health Services Research;3 University of Cincinnati, Cincinnati, OH
Address for correspondence: Alan B. Storrow, MD, Department of Emergency Medicine, 231 Albert Sabin Way, MSB # 6109,
Cincinnati, OH 45267-0769
Manuscript received July 6, 2004; revised October 4, 2004; accepted October 25, 2004

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