{"pk":15145,"title":"Untapped Potential for Emergency Department Observation Unit Use: A National Hospital Ambulatory Medical Care Survey (NHAMCS) Study","subtitle":null,"abstract":"Introduction:\n 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.\nMethods:\n 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.\nResults: \nDuring 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.\nConclusion:\n 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.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"acute coronary syndrome, observation units, troponin, stress tests"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8664d6ns","frozenauthors":[{"first_name":"Angelo","middle_name":"","last_name":"Navas","name_suffix":"","institution":"Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Billy","middle_name":"","last_name":"Guzman","name_suffix":"","institution":"Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Almujtaba","middle_name":"","last_name":"Hassan","name_suffix":"","institution":"King Fahad Armed Forces Hospital, Department of Critical Care Medicine, Jeddah, Kingdom of Saudi Arabia","department":"None"},{"first_name":"Joseph","middle_name":"B.","last_name":"Borawski","name_suffix":"","institution":"Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Dean","middle_name":"","last_name":"Harrison","name_suffix":"","institution":"Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Pratik","middle_name":"","last_name":"Manandhar","name_suffix":"","institution":"Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina","department":"None"},{"first_name":"Alaatin","middle_name":"","last_name":"Erkanli","name_suffix":"","institution":"Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, North Carolina","department":"None"},{"first_name":"Alexander","middle_name":"T.","last_name":"Limkakeng Jr","name_suffix":"","institution":"Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina","department":"None"}],"date_submitted":"2021-02-22T12:21:10-05:00","date_accepted":"2021-02-22T12:21:10-05:00","date_published":"2022-01-19T01:11:21-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/15145/galley/7714/download/"}]}