Key result
ED-based observation centers for intermediate-risk chest pain yielded lower mean costs ($1642 vs $2785), shorter length of stay, and lower 6-month return rates (0.45% vs 3.67%) than inpatient units.
Why the study?
Does management in an ED-based observation center reduce cost, length of stay, and return rates compared to inpatient observation or inpatient units in patients with intermediate-risk chest pain?
Observational (n=2,197)
No
Does management in an ED-based observation center reduce cost, length of stay, and return rates compared to inpatient observation or inpatient units in patients with intermediate-risk chest pain?
Emergency department-based observation centers provide a safe, cost-saving, and efficient alternative to inpatient admission for patients with intermediate-risk chest pain.
May support ED observation centers for intermediate-risk chest pain; leaves open randomized confirmation before practice change.
Chest pain of uncertain etiology (intermediate-risk chest pain [IR-CP]) constitutes a majority of acute chest pain presentations to emergency departments (EDs). A before- and-after trial of 2197 IR-CP patients transferred from the hospital's ED to one of three units-ED-based observation center (ED-OC), inpatient observation center (IN-OC), and inpatient units-compared mean cost, length of stay, and safety over a 2-year period. The mean per patient cost for management of IR-CP was lower in the ED-OC ($1642) than the IN-OC ($1910) or the inpatient units ($2785). The mean length of stay was shorter in the ED-OC (0.75 days) than in the IN-OC (1.18 days) or the inpatient units (2.16 days). Return rates were lower in the ED-OC at 7 days (0%) and at 6 months (0.45%) than the IN-OC (0% and 1.22%) or the inpatient units (0.77% and 3.67%). Overall hospital costs for managing IR-CP dropped significantly (12.5%) after the ED-OC was opened. ED-OCs provide a safe and cost-effective alternative to admission of IR-CP patients.
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Robinson et al. (2002) conducted an observational in Intermediate-risk chest pain (n=2,197). Emergency department-based observation center (ED-OC) vs. Inpatient observation center (IN-OC) and inpatient units was evaluated on Return rates at 6 months. ED-based observation centers for intermediate-risk chest pain yielded lower mean costs ($1642 vs $2785), shorter length of stay, and lower 6-month return rates (0.45% vs 3.67%) than inpatient units.
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