Crit Pathw Cardiol. 2021 Feb 2. doi: 10.1097/HPC.0000000000000253. Online ahead of print.
BACKGROUND: This study objective was to describe changes in the utilization of a protocol driven ED Observation Unit (OU) for chest pain over time.
METHODS: This is a retrospective serial cross-sectional study of data from a clinical data warehouse of a single integrated health care system. We estimated long-term trends (2009-2019) in EDOU visits at four system hospitals, using monthly proportions as the main outcome, and month of visit as the exposure variable, accounting for age and sex. Rate changes associated with compulsory use of the HEART score in 2016 were analyzed.
RESULTS: There were 83,168 EDOU admissions among 1.3 million ED visits during the study interval, with an average admission rate of 5.9% of ED visits. The most common conditions were chest pain (41.2%), TIA (7.8%), Dehydration (6.3%), Syncope (5.8%), and Abdominal Pain (5.2%). In each hospital there was a temporal annual decline in the proportion of EDOU visits for chest pain protocols ranging from -7.9% to -2.8%, an average rate of -3.3% per year (95% CI -4.6% to -2.0%), or a 54% (from 54% to 25%) relative decline in over the 11-year study interval. This decline was significantly steeper in younger middle age patients (ages 39-49). The HEART score intervention had a small impact on baseline decline of -3.1% at the two intervention hospitals, reducing it by -1.5% (95%CI -2.2% to -0.8%).
CONCLUSION: Utilization of the EDOU for chest pain decreased over time, with corresponding increases in other conditions. This decline preceded the introduction of the HEART score.