Key result
Centralized emergency care for acute heart failure is linked to a 2-day shorter hospital stay.
Why the study?
The impact of emergency care centralisation on unscheduled admissions with acute heart failure was unclear.
Does centralisation of emergency care improve outcomes and service efficiency in patients admitted with acute heart failure?
Cohort (n=518)
No
Does centralisation of emergency care improve outcomes and service efficiency in patients admitted with acute heart failure?
Absolute Event Rate: 27.7% vs 32.2%
p-value: p=0.266
Centralisation of specialist emergency care for acute heart failure is associated with improved service efficiency, including reduced length of stay and increased specialist follow-up, without increasing readmissions.
Centralisation of emergency HF care may influence admissions and outcomes; leaves open optimal configuration pending controlled evaluation.
The aim of our study was to describe the impact of emergency care centralisation on unscheduled admissions with a primary discharge diagnosis of acute heart failure (HF). We carried out a retrospective cohort study of HF admissions 1 year before and 1 year after centralisation of three accident and emergency departments into one within a single large NHS trust. Outcomes included mortality, length of stay, readmissions, specialist inpatient input and follow-up, and prescription rates of stabilising medication. Baseline characteristics were similar for 211 patients before and for 307 following reconfiguration. Median length of stay decreased from 8 to 6 days (p=0.020) without an increase in readmissions (4.7% versus 4.2%, p=0.813). The proportion with specialist follow-up increased (60% to 72%, p=0.036). There was a trend towards decreased mortality (32.2% versus 27.7% at 90 days; p=0.266). Contact with the cardiology team was associated with decreased mortality. In conclusion, centralisation of specialist emergency care was associated with greater service efficiency and a trend towards reduced mortality.
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Wilkinson et al. (2019) conducted a cohort in Acute heart failure (n=518). Emergency care centralisation vs. Before centralisation was evaluated on 90-day mortality (p=0.266). Centralisation of emergency care for acute heart failure reduced median length of stay from 8 to 6 days (p=0.020) and showed a trend toward decreased 90-day mortality (27.7% vs 32.2%, p=0.266).
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