Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Exacerbation of Chronic Heart Failure


Study Objective: To determine whether a new emergency department short-stay unit (EDSSU) was an effective alternative to conventional hospital units (HU) for acute exacerbation of chronic heart failure patients. Methods: Design: A comparative analysis was used to identify differences among patients admitted to EDSSU (n = 1546) and those admitted to the internal medicine (n = 552) or cardiology wards (n = 336) during the period of the study (January 1, 2008 to December 31, 2012). Setting: The study was performed at Sant Pau Hospital, a 500-bed teaching tertiary care referral center in Barcelona, Spain. The ED attends about 144,000 emergency visits per year. Participants: We studied retrospectively the characteristics of patients hospitalized with an acute exacerbation of chronic heart failure between January 1, 2008 and December 31, 2012 (n = 2434). We chose charts of patients from the hospital discharge database and selected according to the 9th revision of the International Classification of Diseases Codes. We used the computerized database to obtain outcome data on all patients. Results: Statistically significant differences were found in terms of mean age (HU: 77.38 (14.44) years versus EDSSU: 82.43 (8.72) years; p < 0.001), mean length of stay (HU: 11.57 (10.42) days versus EDSSU: 4.75 (3.18) days; p < 0.001), mortality (HU: 14.0% versus EDSSU: 4.0%; p < 0.001), but not for urgent readmission rate of 30 days or less (HU: 18.30% versus EDSSU: 18.30%; p = 0.998). There were statistically significant differences regarding sex (HU women = 60.6%; EDDSU women = 67.7%; p < 0.001) and number of associated conditions (Charlson index HU = 1.25, EDDSU = 0.90; p < 0.001). Conclusion: The EDSSU proved to be an effective and safe measure in emergency care of patients with acute heart failure (AHF).

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Salazar, A. , Garcia-Eroles, L. , Craywinckel, G. and Corbella, X. (2014) Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Exacerbation of Chronic Heart Failure. International Journal of Clinical Medicine, 5, 1200-1206. doi: 10.4236/ijcm.2014.519153.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Juan, A., Salazar, A., Alvarez, A., Perez, J.R., García, L. and Corbella, X. (2006) Effectiveness and Safety of an Emergency Department Short-Stay Unit as an Alternative to Standard Inpatient Hospitalization. Emergency Medicine Journal, 23, 833-837.
[2] Moloney, E.D., Smith, D., Bennett, K., O’Riordan, D. and Silke, B. (2005) Impact of an Acute Medical Admission Unit on Length of Hospital Stay, and Emergency Department “Wait Times”. QJM: An International Journal of Medicine, 98, 283-289.
[3] Daly, S., Campbell, D.A. and Cameron, P.A. (2003) Short-Stay Units and Observation Medicine: A Systematic Review. Medical Journal of Australia, 178, 559-563.
[4] Rooney, T., Moloney, E.D., Bennett, K., O’Riordan, D. and Silke, B. (2008) Impact of an Acute Medical Admission Unit on Hospital Mortality: A 5-Year Prospective Study. QJM: An International Journal of Medicine, 101, 457-465.
[5] Scott, I., Vaughan, L. and Bell, D. (2009) Effectiveness of Acute Medical Units in Hospitals: A Systematic Review. International Journal for Quality in Health Care, 21, 397-407.
[6] Baugh, C.W., Venkatesh, A.K. and Bohan, J.S. (2011) Emergency Department Observation Units: A Clinical and Financial Benefit for Hospitals. Health Care Management Review, 36, 28-37.
[7] Burkhardt, J., Peacock, W.F. and Emerman, C.L. (2005) Predictors of Emergency Department Observation Unit Outcomes. Academic Emergency Medicine, 12, 869-874.
[8] Salazar, A., Juan, A., Ballbé, R. and Corbella, X. (2007) Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Chronic Obstructive Pulmonary Disease Exacerbation. American Journal of Emergency Medicine, 25, 486-487.
[9] Rydman, R.J., Roberts, R.R., Albrecht, G.L., et al. (1999) Patient Satisfaction with an Emergency Department Asthma Observation Unit. Academic Emergency Medicine, 6, 178-183.
[10] Robertson, J., McElduff, P., Pearson, S.-A., Henry, D.A., Inder, K.J. and Attia, J.R. (2012) The Health Services Burden of Heart Failure: An Analysis Using Linked Population Health Data-Sets. BMC Health Services Research, 12, 103.
[11] Ezekowitz, J.A., Bakal, J.A., Kaul, P., Westerhout, C.M. and Armstrong, P.W. (2008) Acute Heart Failure in the Emergency Department: Short and Long-Term Outcomes of Elderly Patients with Heart Failure. European Journal of Heart Failure, 10, 308-314.
[12] US Government Accountability Office (2009) Hospital Emergency Departments: Crowding Continued to Occur, and Some Patients Wait Longer than Recommended Time Frames, GAO-09-347. Washington DC.
[13] Forster, A.J., Stiell, I., Wells, G., Lee, A.J. and van Walraven, C. (2003) The Effect of Hospital Occupancy on Emergency Department Length of Stay and Patient Disposition. Academic Emergency Medicine, 10, 127-133.
[14] Kellermann, A.L. (2006) Crisis in the Emergency Department. The New England Journal of Medicine, 355, 1300-1303.
[15] Hoot, N.R. and Aronsky, D. (2008) Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Annals of Emergency Medicine, 52, 126-136.
[16] Forero, R., McCarthy, S. and Hillman, K. (2011) Access Block and Emergency Department Overcrowding. Critical Care, 15, 216.
[17] Peacock, W.F., Young, J., Collins, S., Diercks, D. and Emerman, C. (2006) Review Heart Failure Observation Units: Optimizing Care. Annals of Emergency Medicine, 47, 22-33.
[18] Storrow, A.B., Collins, S.P., Lyons, M.S., Wagoner, L.E., Gibler, W.B. and Lindsell, C.J. (2005) Emergency Department Observation of Heart Failure: Preliminary Analysis of Safety and Cost. Congestive Heart Failure, 11, 68-72.
[19] Collins, S.P., Shauer, D.P., Gupta, A., Brunner, H., Storrow, A.B. and Eckman, M.H. (2009) Cost-Effectiveness Analysis of ED Decision Making in Patients with Non-High-Risk Heart Failure. The American Journal of Emergency Medicine, 27, 293-302.
[20] Diercks, D.B., Peacock, W.F., Kirk, J.D. and Weber, J.E. (2006) ED Patients with Heart Failure: Identification of an Observational Unit-Appropriate Cohort. The American Journal of Emergency Medicine, 24, 319-324.
[21] (1993) International Classification of Diseases, 9th Revision, Clinical Modifications. 4th Edition, Med-Index Publications, Salt Lake City.
[22] Formiga, F., Vidaller, A., Salazar, A. and Pujol, R. (2005) Nonagenarian’s Use of Emergency Departments. Age & Ageing, 34, 412-418.
[23] Kellermann, A.L. and Martinez, R. (2011) The ER, 50 Years on. The New England Journal of Medicine, 364, 2278-2279.
[24] Han, J.H., Zhou, C., France, D.J., Zhong, S., Jones, I., Storrow, A.B., et al. (2007) The Effect of Emergency Department Expansion on Emergency Department Overcrowding. Academic Emergency Medicine, 14, 338-343.
[25] Khare, R.K., Powell, E.S., Reinhardt, G. and Lucenti, M. (2009) Adding More Beds to the Emergency Department or Reducing Admitted Patient Boarding Times: Which Has a More Significant Influence on Emergency Department Congestion? Annals of Emergency Medicine, 53, 575-585.
[26] Greene, J. (2007) Emergency Department Flow and the Boarded Patient: How to Get Admitted Patients Upstairs. Annals of Emergency Medicine, 49, 68-70.
[27] Wong, H.J., Morra, D., Caesar, M., Carter, M.W. and Abrams, H. (2010) Understanding Hospital and Emergency Department Congestion: An Examination of Inpatient Admission Trends and Bed Resources. Canadian Journal of Emergency Medicine, 12, 18-26.
[28] Salazar, A., Corbella, X., Onaga, H., Ramon, R., Pallarés, R. and Escarrabill, J. (2001) Impact of a Resident Strike on Emergency Department Quality Indicators at an Urban Teaching Hospital. Academic Emergency Medicine, 8, 804-808.
[29] Salazar, A., Corbella, X., Sánchez, J.L., Argimón, J.M. and Escarrabill, J. (2002) How to Manage the ED Crisis When Hospital and or ED Capacity Is Reaching Its Limits? Report about Implementation of Particular Interventions during the Christmas Crisis. European Journal of Emergency Medicine, 9, 79-80.
[30] Salazar, A., Estrada, C., Porta, R., Lolo, M., Tomas, S. and Alvarez, M. (2009) Home Hospitalization Unit: An Alternative to Standard Inpatient Hospitalization from the Emergency Department. European Journal of Emergency Medicine, 16, 121-123.
[31] Gómez-Vaquero, C., Soler, A.S., Pastor, A.J., Mas, J.R.P., Rodriguez, J.J. and Virós, X.C. (2009) Efficacy of a Holding Unit to Reduce Access Block and Attendance Pressure in the Emergency Department. Emergency Medicine Journal, 26, 571-572.
[32] Corbella, X., Ortiga, B., Juan, A., Ortega, N., Gómez, C., Capdevila, C., Bardés, I., Alonso, G., Ferré, C., Soler, M., Máñez, R., Jaurrieta, E., Pujol, R. and Salazar, A. (2013) Alternatives to Conventional Hospitalization for Improving Lack of Access to Inpatient Beds: A 12-Year Cross-Sectional Analysis. Journal of Hospital Administration, 2, 9-21.
[33] Levin, S.R., Dittus, R., Aronsky, D., Weinger, M.B., Han, J., Boord, J., et al. (2008) Optimizing Cardiology Capacity to Reduce Emergency Department Boarding: A Systems Engineering Approach. American Heart Journal, 156, 1202-1209.
[34] Epstein, A.M., Jha, A.K. and Orav, E.J. (2011) The Relationship between Hospital Admission Rates and Rehospitalizations. The New England Journal of Medicine, 365, 2287-2295.
[35] Bueno, H., Ross, J.S., Wang, Y., Chen, J., Vidán, M.T., Normand, S.L.T., et al. (2010) Trends in Length of Stay and Short-Term Outcomes among Medicare Patients Hospitalized for Heart Failure: 1993-2008. JAMA, 303, 2141-2147.

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