Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Acad Emerg Med. 2013 Jun;20(6):554-61. doi: 10.1111/acem.12147.
The objective was to compare readmission rates and hospital bed-days between acute decompensated heart failure (AHF) patients admitted or discharged following accelerated treatment protocol (ATP)-driven care in an emergency department observation unit (OU).
This was a retrospective cohort study conducted at two urban university-affiliated hospitals. A total of 358 selected AHF patients received treatment on an ATP in the OU between October 1, 2007, and June 30, 2011. The comparison of interest was admission or discharge following OU treatment. The outcome of interest was readmission within 30 and 90 days of hospital discharge following care in the OU. We also examined resource use (inpatient, inpatient plus outpatient-days) between the admitted and discharged groups. Time to readmission analysis was performed with Cox proportional hazards regression.
Discharged and admitted patients were similar with respect to age, race, sex, ED length of stay (LOS), and OU LOS. Patients admitted from the OU had a higher median B-type natriuretic peptide (BNP; 1,063 pg/mL [interquartile range {IQR} = 552 to 2,067 pg/mL] vs. 708 pg/mL [IQR = 254 to 1,683 pg/mL]; p = 0.002) and blood urea nitrogen (BUN; 19 mg/dL [IQR = 14 to 26 mg/dL] vs. 17 mg/dL [IQR = 13 to 23 mg/dL]) than those discharged (p = 0.04) and a lower median ejection fraction (EF; 22.5% [15% to 43%] vs. 35% [IQR 20% to 55%]; p = 0.002). In models controlling for age, race, sex, clinical site, BNP, BUN, creatinine, and EF, the 30-day readmission rate (13.8% in the study population as a whole) was not significantly different between the patients discharged or admitted following OU care (hazard ratio [HR] = 0.99; 95% confidence interval [CI] = 0.47 to 2.10). The readmission rates were also not significantly different at 90 days (HR = 1.07; 95% CI = 0.65 to 1.77). Within 30 days of discharge from the OU, patients spent a median of 1.7 days (IQR = 0.0 to 5.1 days) as inpatients, compared to 3.5 days (IQR = 2.3 to 5.8 days) among patients admitted from the OU (p < 0.0001). Among readmitted patients, the total median inpatient time was not significantly different between the comparison groups at both 30 and 90 days of follow-up.
Selected acute heart failure (HF) patients managed by a rapid treatment protocol in the OU demonstrated favorable hospital use, with discharged patients using fewer bed-days and demonstrating readmission rates that were not higher than admitted patients.
比较在急诊科观察单元（OU）接受加速治疗方案（ATP）驱动的治疗后出院或留院的急性失代偿性心力衰竭（AHF）患者的再入院率和住院天数。
这是在两家城市大学附属医院进行的回顾性队列研究。2007 年 10 月 1 日至 2011 年 6 月 30 日，共有 358 名选定的 AHF 患者在 OU 接受 ATP 治疗。感兴趣的比较是 OU 治疗后的入院或出院。OU 治疗后 30 天和 90 天内的再入院是感兴趣的结局。我们还检查了留院和出院患者之间的资源使用情况（住院、住院加门诊天数）。采用 Cox 比例风险回归进行再入院时间分析。
在年龄、种族、性别、急诊科住院时间（LOS）和 OU LOS 方面，出院和留院患者相似。从 OU 留院的患者 B 型利钠肽（BNP）中位数更高（1063 pg/mL [四分位距 {IQR} = 552 至 2067 pg/mL] 比 708 pg/mL [IQR = 254 至 1683 pg/mL]；p = 0.002）和血尿素氮（BUN）中位数更高（19 mg/dL [IQR = 14 至 26 mg/dL] 比 17 mg/dL [IQR = 13 至 23 mg/dL]）（p = 0.04），而射血分数（EF）中位数更低（22.5% [15%至 43%] 比 35% [IQR 20%至 55%]；p = 0.002）。在控制年龄、种族、性别、临床地点、BNP、BUN、肌酐和 EF 的模型中，整体研究人群的 30 天再入院率（13.8%）在接受 OU 治疗后出院或留院的患者之间没有显著差异（风险比 [HR] = 0.99；95%置信区间 [CI] = 0.47 至 2.10）。90 天的再入院率也没有显著差异（HR = 1.07；95%CI = 0.65 至 1.77）。在 OU 出院后 30 天内，与 OU 入院患者相比（中位数 3.5 天 [IQR = 2.3 至 5.8 天]），留院患者的平均住院时间中位数为 1.7 天（IQR = 0.0 至 5.1 天）（p < 0.0001）。在再入院患者中，30 天和 90 天随访时，比较组的总住院时间中位数没有显著差异。
在 OU 接受快速治疗方案治疗的选定急性心力衰竭（HF）患者表现出良好的住院利用情况，出院患者使用的住院天数更少，且再入院率并不高于入院患者。
