Untapped Potential for Emergency Department Observation Unit Use: A National Hospital Ambulatory Medical Care Survey (NHAMCS) Study.
Abstract
<h4>Introduction</h4>Millions of people present to the emergency department (ED) with
chest pain annually. Accurate and timely risk stratification is important to identify
potentially life-threatening conditions such as acute coronary syndrome (ACS). An
ED-based observation unit can be used to rapidly evaluate patients and reduce ED crowding,
but the practice is not universal. We estimated the number of current hospital admissions
in the United States (US) eligible for ED-based observation services for patients
with symptoms of ACS.<h4>Methods</h4>In this cross-sectional analysis we used data
from the 2011-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits
were included if patients presented with symptoms of ACS (eg, chest pain, dyspnea),
had an electrocardiogram (ECG) and cardiac markers, and were admitted to the hospital.
We excluded patients with any of the following: discharge diagnosis of myocardial
infarction; cardiac arrest; congestive heart failure, or unstable angina; admission
to an intensive care unit; hospital length of stay > 2 days; alteplase administration,
central venous catheter insertion, cardiopulmonary resuscitation or endotracheal intubation;
or admission after an initial ED observation stay. We extracted data on sociodemographics,
hospital characteristics, triage level, disposition from the ED, and year of ED extracted
from the NHAMCS. Descriptive statistics were performed using sampling weights to produce
national estimates of ED visits. We provide medians with interquartile ranges for
continuous variables and percentages with 95% confidence intervals for categorical
variables.<h4>Results</h4>During 2011-2015 there were an estimated 675,883,000 ED
visits in the US. Of these, 14,353,000 patients with symptoms of ACS and an ED order
for an ECG or cardiac markers were admitted to the hospital. We identified 1,883,000
visits that were amenable to ED observation services, where 987,000 (52.4%) were male
patients, and 1,318,000 (70%) were White. Further-more, 739,000 (39.2%) and 234,000
(12.4%) were paid for by Medicare and Medicaid, respectively. The majority (45.1%)
of observation-amenable hospitalizations were in the Southern US.<h4>Conclusion</h4>Emergency
department-based observation unit services for suspected ACS appear to be underused.
Over half of potentially observation-amenable admissions were paid for by Medicare
and Medicaid. Implementation of ED-based observation units would especially benefit
hospitals and patients in the American South.
Type
Journal articleSubject
HumansCross-Sectional Studies
Aged
Emergency Service, Hospital
Hospitals
Medicare
United States
Male
Clinical Observation Units
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https://hdl.handle.net/10161/24786Published Version (Please cite this version)
10.5811/westjem.2021.8.52231Publication Info
Navas, Angelo; Guzman, Billy; Hassan, Almujtaba; Borawski, Joseph B; Harrison, Dean;
Manandhar, Pratik; ... Limkakeng, Alexander T (2022). Untapped Potential for Emergency Department Observation Unit Use: A National Hospital
Ambulatory Medical Care Survey (NHAMCS) Study. The western journal of emergency medicine, 23(2). pp. 134-140. 10.5811/westjem.2021.8.52231. Retrieved from https://hdl.handle.net/10161/24786.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joseph Brian Borawski
Assistant Professor of Emergency Medicine
Alaattin Erkanli
Associate Professor of Biostatistics & Bioinformatics
Areas of research interests include Bayesian hierarchical models for longitudinal
data, Bayesian optimal designs, finite mixtures and Mixtures of Dirichlet Processes,
Markov transition models, nonparametrics smoothing and density estimation, survival
analysis for recurrent-event data, biomarker selection and detecting early ovarian
cancer.
Alexander Tan Limkakeng Jr.
Professor of Emergency Medicine
My personal research interest is finding new ways to diagnose acute coronary syndrome.
In particular, I am interested in novel biomarkers and precision medicine approaches
to this problem. I also have an interest in sepsis and empirical bioethics. As Vice
Chair of Clinical Research for the Duke University Department of Emergency Medicine,
I also work with researchers from many fields spanning global health, innovation,
clinical trials, basic discovery, and trans
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