National Cost Savings From Observation Unit Management of Syncope
National Cost Savings From Observation Unit Management of Syncope
复制标题
DOI：
10.1111/acem.12720
复制
发表时间：
2015-08-01
影响因子：
4.4
通讯作者：
Sun, Benjamin C.
中科院分区：
文献类型：
--
作者：
Baugh, Christopher W.;Liang, Li-Jung;Sun, Benjamin C.
晕厥是一种常见的急诊科（艾德）的投诉，并导致不成比例的住院率与可变的管理策略。我们的目标是估计每年的国家成本节约，减少住院病人的住院治疗，并减少在医院病床上的时间从实施protocolized护理在observationunit.MethodsWe创建了一个Monte Carlo模拟，通过建立一个模型，反映了目前在美国的临床实践，并使用输入收集到的最新的同行评议的文献和国家调查数据。调整了艾德访视量，以反映观察单元的可用性和需要后续住院治疗的观察访视部分。最近的一项多中心随机对照研究报告了每次观察单位访视模型输入的成本节约和住院时间缩短。研究人群包括年龄在50岁及以上的晕厥患者，这些患者被认为是严重30天心血管结局的中等风险。（+/-8900万美元），避免235000美元（+/-13，900）住院病人，导致4，297，000人（+/-1，242，000）更少的医院病床hours.ConclusionsThe潜在的国家成本节约管理选定的晕厥患者在一个专门的观察单位是巨大的。晕厥是适合在观察室护理的许多情况之一，作为住院治疗的替代方案。随着观察时间的增加，缩短住院时间的压力和短期住院费用的增加，晕厥说明了观察病房护理的价值。(C)2015年由学术急诊医学学会
ObjectivesSyncope is a frequent emergency department (ED) presenting complaint and results in a disproportionate rate of hospitalization with variable management strategies. The objective was to estimate the annual national cost savings, reduction in inpatient hospitalizations, and reduction in hospital bed hours from implementation of protocolized care in an observation unit.MethodsWe created a Monte Carlo simulation by building a model that reflects current clinical practice in the United States and uses inputs gathered from the most recent available peer-reviewed literature and national survey data. ED visit volume was adjusted to reflect observation unit availability and the portion of observation visits requiring subsequent inpatient care. A recent multicenter randomized controlled study informed the cost savings and length of stay reduction per observation unit visit model inputs. The study population included patients aged 50years and older with syncope deemed at intermediate risk for serious 30-day cardiovascular outcomes.ResultsThe mean (SD) annual cost savings was estimated to be $108 million (+/-$89 million) from avoiding 235,000 (+/- 13,900) inpatient admissions, resulting in 4,297,000 (+/- 1,242,000) fewer hospital bed hours.ConclusionsThe potential national cost savings for managing selected patients with syncope in a dedicated observation unit is substantial. Syncope is one of many conditions suitable for care in an observation unit as an alternative to an inpatient setting. As pressure to decrease hospital length of stay and bill short-stay hospitalizations as observation increases, syncope illustrates the value of observation unit care. (C) 2015 by the Society for Academic Emergency Medicine