Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain

Abstract

There were higher rates of cardiac catheterization and PCI among those admitted as a short inpatient compared to observation, while the incidence of subsequent AMI within 30 days was similar.

Predicting re‐presentation following discharge from the emergency department with non‐specific chest pain

“…Patients with NSCP comprised 3.4% of all presentations to the two EDs examined in this study, which aligns with other Australian data. While cardiac mortality and risk of future cardiac events are important considerations, they are relatively rare outcomes in this patient group . The 30 day ED re‐presentation rate in our cohort (<10%), is lower than previously published rates in other non‐ACS chest pain groups and well below ED re‐presentation rates for other common conditions.…”

“…The strength of this study is that it looked at patients with an ED diagnosis of NSCP and therefore the findings are readily applicable to the ED physician. Unlike previous large studies in this area, the patients admitted to the ED observation units in the present study were cared for by ED clinicians within a defined location immediately adjacent to the ED proper.…”

“…The evaluation of chest pain in the ED is currently focussed more on risk stratification than on diagnosis . Leaving the ED without a diagnosis for presenting symptoms invites dissatisfaction or anxiety about risk of disease or death, yet up to 60% leave the ED with no diagnosis for their pain .…”

Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use

“…Medical claims include International Classification of Diseases, 9th and 10th Revision procedure and diagnosis codes; Healthcare Common Procedure Coding System (HCPCS) procedure codes; site of service codes; and provider specialty codes. 31 The commercial population covered by OLDW is similar to the United States population of commercially insured people in age, race/ethnicity, and gender. Further detail is provided in web appendices.…”

Observation Versus Inpatient Stay for Heart Failure: Is It Semantics?

“…This is different from the results of the current study by Masri et al, 12 raising the question of whether it may be easier to prognosticate patients with chest pain and predetermine hospitalization status, compared with those with HF. Bellolio et al conducted a similar study, whereby the investigators compared observation status with short inpatient stay (<48 hours) in patients presenting with chest pain 15. The primary goal was to compare healthcare use between the 2 groups, by looking at number of cardiac procedures performed, but the authors also studied differences in 30‐day myocardial infarction rate.…”