Highlights
- •Short-stay units improve the safety of discharged patients from Emergency Department.
- •Short-stays units increase the number of emergency admissions.
- •Short-stay units reduce the length of stay of admitted patients.
- •Short-stay units are as safe as medical wards.
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).
Method
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 30 days 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 ± 9.5 days, being 2.2 days 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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995.Am Heart J. 1999; 137: 352-360
- Containing the cost of heart failure management: a focus on reducing readmissions.Card Electrophysiol Clin. 2015; 7: 577-584
- Register of short-stay units in Spain, the REGICE project, study 1: location, organizational features, and staffing.Emergencias. 2014; 26: 57-60
- Clinical management of short-stay units in Spain: the REGICE 2 study.Emergencias. 2014; 26: 359-362
- Predictors of emergency department observation unit outcomes.Acad Emerg Med. 2005; 12: 869-874
- Effectiveness and safety of short-stay units in the emergency department: a systematic review.Acad Emerg Med. 2015; 22: 893-907
- Consensus on improving the care integrated of patients with acute heart failure.Emergencias. 2015; 27: 245-266
- Prolonged hospitalization in patients admitted for acute heart failure in the short stay unit (EPICA-UCE study): study of associated factors.Med Clin (Barc). 2014; 143: 245-251
- Short-stay units and observation medicine: a systematic review.Med J Aust. 2003; 178: 559-563
- Effectiveness and safety of an emergency department short-stay unit as an alternative to standard inpatient hospitalisation.Emerg Med J. 2006; 23: 833-837
- Spanish short-stay-units: results according to department designated to manage the unit.Emergencias. 2015; 27: 109-112
- Factors associated with short stays for patients admitted with acute heart failure.Emergencias. 2016; 28: 366-374
- The natural history of congestive heart failure: the Framingham study.N Engl J Med. 1971; 285: 1441-1446
- Patients' perception of quality of emergency department care for acute heart failure: the CALPERICA study.Emergencias. 2015; 27: 161-168
- Characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: results based on the EAHFE registry (epidemiology of acute heart failure in emergency departments).Emergencias. 2015; 27: 11-22
- Do outcomes for patients with heart failure vary by emergency department volume?.Circ Heart Fail. 2013; 6: 1147-1154
- The burden of acute heart failure on U.S. emergency departments.JACC Heart Fail. 2014; 2: 269-277
- Acute heart failure in the emergency department: short and long-term outcomes of elderly patients with heart failure.Eur J Heart Fail. 2008; 10: 308-314
- Early deaths in patients with heart failure discharged from the emergency department: a population-based analysis.Circ Heart Fail. 2010; 3: 228-235
- Multicentric investigation of survival after Spanish emergency department discharge for acute heart failure.Eur J Emerg Med. 2012; 19: 153-160
- Risks and benefits of risk prediction in acute heart failure.JACC Heart Fail. 2015; 3: 748-750
- When and for how long do patients with AHF have to be admitted?.Emergencias. 2016; 28: 363-365
- Society of Chest Pain Centers recommendations for the evaluation and management of the observation stay acute heart failure patient-parts 1-6.Acute Card Care. 2009; 11: 3-42
- European Society of Cardiology - acute cardiovascular care association position paper on safe discharge of acute heart failure patients from the emergency department.Eur Heart J Acute Cardiovasc Care. 2016; (in press)https://doi.org/10.1177/2048872616633853
- Disposition of emergency department patients diagnosed with acute heart failure: an international emergency medicine perspective.Eur J Emerg Med. 2017; 24: 2-12
- Acute heart failure in Spain: certainties and uncertainties.Emergencias. 2015; 27: 7-9
- Cardiovascular research continuity: a call for greater collaboration between cardiology and emergency care researchers.Emergencias. 2015; 27: 396-398
Explotación del registro de altas CMBD del Sistema Nacional de Salud. Ministerio de Sanidad, Política Social e Igualdad. [cited: 9th january 2015]. Disponible en: http://www.msssi.gob.es/estadEstudios/estadisticas/cmbd/informes/2008_2011/7_Principales_indicadores_de_los_20_GRD_mas_frecuentes/7_Principales_indicadores_de_los_20_GRD_mas_frecuentes.html
- Trends in length of stay and short-term outcomes among medicare patients hospitalized for heart failure, 1993–2006.JAMA. 2010; 303: 2141-2147
Article info
Publication history
Published online: January 23, 2017
Accepted:
January 17,
2017
Received in revised form:
January 4,
2017
Received:
September 19,
2016
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
