Òscar Miró1, Virginia Carbajosa2, W Frank Peacock3, Pere Llorens4, Pablo Herrero5, Javier Jacob6, Sean P Collins7, Cristina Fernández8, Antoni Juan Pastor9, Francisco Javier Martín-Sánchez10. 1. Área de Urgencias, Hospital Clínic, Barcelona, Spain; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, Spain. 2. Servicio de Urgencias, Hospital Universitario Rio-Hortega, Valladolid, Spain. 3. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. 4. Servicio de Urgencias, CortaEstancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain. 5. Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain. 6. Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 7. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 8. 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. 9. Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain. 10. 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. Electronic address: fjjms@hotmail.com.
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 30days 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±9.5days, being 2.2days 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.
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 30days 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±9.5days, being 2.2days 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.
Authors: Andrea Sonaglioni; Chiara Lonati; Lisa Tescaro; Gian Luigi Nicolosi; Marco Proietti; Michele Lombardo; Sergio Harari Journal: Aging Clin Exp Res Date: 2022-01-06 Impact factor: 4.481
Authors: Josep Masip; W Frank Peacok; Mattia Arrigo; Xavier Rossello; Elke Platz; Louise Cullen; Alexandre Mebazaa; Susanna Price; Héctor Bueno; Salvatore Di Somma; Mucio Tavares; Martin R Cowie; Alan Maisel; Christian Mueller; Òsar Miró Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-02-08