Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation

Shawna D. Bellew, Merri L. Bremer, Stephen L. Kopecky, Christine M. Lohse, Thomas M. Munger, Paul M. Robelia, Peter A. Smars

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background-Atrial fibrillation (AF) is a common, growing, and costly medical condition. We aimed to evaluate the impact of a management algorithm for symptomatic AF that used an emergency department observation unit on hospital admission rates and patient outcomes. Methods and Results-This retrospective cohort study compared 563 patients who presented consecutively in the year after implementation of the algorithm, from July 2013 through June 2014 (intervention group), with 627 patients in a historical cohort (preintervention group) who presented consecutively from July 2011 through June 2012. All patients who consented to have their records used for chart review were included if they had a primary final emergency department diagnosis of AF. We observed no significant differences in age, sex, vital signs, body mass index, or CHADS2 (congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke or transient ischemic attack) score between the preintervention and intervention groups. The rate of inpatient admission was significantly lower in the intervention group (from 45% to 36%; P<0.001). The groups were not significantly different with regard to rates of return emergency department visits (19% versus 17%; P=0.48), hospitalization (18% versus 16%; P=0.22), or adverse events (2% versus 2%; P=0.95) within 30 days. Emergency department observation unit admissions were 40% (P<0.001) less costly than inpatient hospital admissions of ≤ 1 day's duration. Conclusions-Implementation of an emergency department observation unit AF algorithm was associated with significantly decreased hospital admissions without increasing the rates of return emergency department visits, hospitalization, or adverse events within 30 days.

Original languageEnglish (US)
Article numbere002984
JournalJournal of the American Heart Association
Volume5
Issue number2
DOIs
StatePublished - 2016

Fingerprint

Atrial Fibrillation
Hospital Emergency Service
Observation
Inpatients
Hospitalization
Hospital Units
Vital Signs
Patient Admission
Transient Ischemic Attack
Diabetes Mellitus
Body Mass Index
Cohort Studies
Heart Failure
Retrospective Studies
Stroke
Hypertension

Keywords

  • Anticoagulants
  • Arrhythmia
  • Fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bellew, S. D., Bremer, M. L., Kopecky, S. L., Lohse, C. M., Munger, T. M., Robelia, P. M., & Smars, P. A. (2016). Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation. Journal of the American Heart Association, 5(2), [e002984]. https://doi.org/10.1161/JAHA.115.002984

Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation. / Bellew, Shawna D.; Bremer, Merri L.; Kopecky, Stephen L.; Lohse, Christine M.; Munger, Thomas M.; Robelia, Paul M.; Smars, Peter A.

In: Journal of the American Heart Association, Vol. 5, No. 2, e002984, 2016.

Research output: Contribution to journalArticle

Bellew, SD, Bremer, ML, Kopecky, SL, Lohse, CM, Munger, TM, Robelia, PM & Smars, PA 2016, 'Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation', Journal of the American Heart Association, vol. 5, no. 2, e002984. https://doi.org/10.1161/JAHA.115.002984
Bellew, Shawna D. ; Bremer, Merri L. ; Kopecky, Stephen L. ; Lohse, Christine M. ; Munger, Thomas M. ; Robelia, Paul M. ; Smars, Peter A. / Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 2.
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