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The effect of a short-stay unit on hospital admission and length of stay in acute heart failure: REDUCE-AHF study

  • Òscar Miró
    Affiliations
    Área de Urgencias, Hospital Clínic, Barcelona, Spain

    Grupo de Investigación “Urgencias: Procesos y Patologías”, IDIBAPS, Barcelona, Spain
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  • Virginia Carbajosa
    Affiliations
    Servicio de Urgencias, Hospital Universitario Rio-Hortega, Valladolid, Spain
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  • W. Frank Peacock
    Affiliations
    Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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  • Pere Llorens
    Affiliations
    Servicio de Urgencias, CortaEstancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
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  • Pablo Herrero
    Affiliations
    Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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  • Javier Jacob
    Affiliations
    Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Sean P. Collins
    Affiliations
    Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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  • Cristina Fernández
    Affiliations
    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
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  • Antoni Juan Pastor
    Affiliations
    Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
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  • Francisco Javier Martín-Sánchez
    Correspondence
    Corresponding author at: Emergency Department, Hospital Clínico San Carlos, Madrid, Spain.
    Affiliations
    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
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  • on behalf of the ICA-SEMES group
    Author Footnotes
    1 Remaining members of the ICA-SEMES group: José Manuel Garrido (Hospital Virgen de la Macarena, Sevilla), Héctor Alonso (Hospital Marqués de Valdecilla, Santander) Cristina Gil, Marta Fuentes (Hospital Universitario de Salamanca). Esther Rodríguez Adrada, Javier Perdigones, Luis Escobar (Hospital Clínico San Carlos, Madrid). Víctor Gil, Rosa Escoda, Sira Aguiló (Hospital Clínic de Barcelona), María José Pérez-Durá, Eva Salvo (Hospital La Fe de Valencia). José Pavón, Ana Bella Álvarez (Hospital Dr. Negrín de Las Palmas de Gran Canaria). Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria). José M. Torres (Hospital Reina Sofía de Córdoba). María Luisa López-Grima, Amparo Valero, María Ángeles Juan-Gómez (Hospital Dr. Peset de Valencia). Alfons Aguirre, Maria Àngels Pedragosa (Hospital del Mar de Barcelona). Maria Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla). José Miguel Franco (Hospital Miguel Servet de Zaragoza). Sergio Pardo (Hospital San Juan de Alicante). Ana Belén Mecina, Rocío Merino Genicio (Hospital de Alcorcón). Josep Tost, Belén de la Fuente Penco, Antònia López Sánchez (Consorci Sanitari de Terrassa). Jordi Fabregat (Hospital Mutua de Terrasa). Susana Sánchez (Hospital Rio Ortega de Valladolid). Pascual Piñera (Hospital Reina Sofía de Murcia). Raquel Torres Garate (Hospital Severo Ochoa). Aitor Alquezar, Miguel Alberto Rizzi (Hospital San Pau de Barcelona). Irene Cabello (Hospital Universitari de Bellvitge, Barcelona). Fernando Richard, José María Álvarez Pérez, Maria Pilar López Diez. (Hospital Universitario de Burgos), Javier Lucas (Hospital General de Albacete). Joaquin Vázquez Alvarez, Ana Alonso Morilla, Andrea Irimia (Hospital Universitario Central de Asturias). Patricia Jav aloyes, Isis Baño (Hospital General de Alicante).
  • Author Footnotes
    1 Remaining members of the ICA-SEMES group: José Manuel Garrido (Hospital Virgen de la Macarena, Sevilla), Héctor Alonso (Hospital Marqués de Valdecilla, Santander) Cristina Gil, Marta Fuentes (Hospital Universitario de Salamanca). Esther Rodríguez Adrada, Javier Perdigones, Luis Escobar (Hospital Clínico San Carlos, Madrid). Víctor Gil, Rosa Escoda, Sira Aguiló (Hospital Clínic de Barcelona), María José Pérez-Durá, Eva Salvo (Hospital La Fe de Valencia). José Pavón, Ana Bella Álvarez (Hospital Dr. Negrín de Las Palmas de Gran Canaria). Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria). José M. Torres (Hospital Reina Sofía de Córdoba). María Luisa López-Grima, Amparo Valero, María Ángeles Juan-Gómez (Hospital Dr. Peset de Valencia). Alfons Aguirre, Maria Àngels Pedragosa (Hospital del Mar de Barcelona). Maria Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla). José Miguel Franco (Hospital Miguel Servet de Zaragoza). Sergio Pardo (Hospital San Juan de Alicante). Ana Belén Mecina, Rocío Merino Genicio (Hospital de Alcorcón). Josep Tost, Belén de la Fuente Penco, Antònia López Sánchez (Consorci Sanitari de Terrassa). Jordi Fabregat (Hospital Mutua de Terrasa). Susana Sánchez (Hospital Rio Ortega de Valladolid). Pascual Piñera (Hospital Reina Sofía de Murcia). Raquel Torres Garate (Hospital Severo Ochoa). Aitor Alquezar, Miguel Alberto Rizzi (Hospital San Pau de Barcelona). Irene Cabello (Hospital Universitari de Bellvitge, Barcelona). Fernando Richard, José María Álvarez Pérez, Maria Pilar López Diez. (Hospital Universitario de Burgos), Javier Lucas (Hospital General de Albacete). Joaquin Vázquez Alvarez, Ana Alonso Morilla, Andrea Irimia (Hospital Universitario Central de Asturias). Patricia Jav aloyes, Isis Baño (Hospital General de Alicante).
Published:January 23, 2017DOI:https://doi.org/10.1016/j.ejim.2017.01.015

      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

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