Background: The best management of patients with isolated blunt thoracic trauma at high risk of pulmonary complications (HRPC-BTT: ≥3 isolated rib fractures, sternal fracture, single or few pulmonary contusions or minimal pneumothorax) is still unclear. We compared efficacy and cost-effectiveness of a new clinical pathway involving an Emergency Department Observation Unit (EDOU) with routine care.
Design: Retrospective before-after study.
Setting: Level II Trauma Center within a Regional Teaching Hospital.
Participants: A consecutive series of patients with HRPC-BTT.
Interventions: a new clinical pathway involving EDOU was implemented.
Main Outcomes: Death rate, tube thoracostomy, and re-admission of discharged patients. Hospital admission rate, length of hospital occupancy, overall costs, and cost-effectiveness were also compared in pre- and post-EDOU period.
Results: Two hundred forty patients were eligible for the study: 110 patients in the pre-EDOU period and 130 in the post-EDOU period. Thirteen (12%) of the treated patients were re-admitted to the ED in the pre-EDOU period compared with only five (4%) when the EDOU was available (p = 0.03). The rate of tube thoracostomy performed in admitted patients significantly increased after EDOU implementation: 1 of 54 (1.9%) versus 4 of 32 (12.5%; p < 0.05). The rate of hospitalization decreased from 49% in the pre-EDOU period to 24% in the post-EDOU period (p < 0,005) and the length of stay in hospital in the pre-EDOU period was longer than in the EDOU period: mean 94.7 ± 79.6 versus 65.7 ± 60.6, respectively (p < 0.02). Cost analysis revealed no relevant change in cost-effectiveness per patient (median; interquartile range): €487; €103 to 1959 versus €616; €124 to 1455, respectively, in the pre- and post-EDOU period.
Conclusions: In managing patients affected by HRPC-BTT, a clinical pathway involving the EDOU seems to be more effective than routine care with little impact on cost.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TA.0b013e3182140cad | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
An observation unit may help improve an institution's Press Ganey satisfaction score.
Crit Pathw Cardiol
June 2011
Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Background: : Hospitals measure patient satisfaction through Press Ganey (PG) surveys. The impact of an emergency department observation unit (EDOU) on patient satisfaction has not been reported to date. We hypothesize that an EDOU has a positive impact on patient satisfaction results as measured by PG surveys.
View Article and Find Full Text PDFA management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study.
J Trauma Acute Care Surg
January 2012
Department of Emergency Medicine, Medicina e Chirurgia d'Accettazione e d'Urgenza Ospedali Riuniti di Ancona, Ancona, Italy.
Background: The best management of patients with isolated blunt thoracic trauma at high risk of pulmonary complications (HRPC-BTT: ≥3 isolated rib fractures, sternal fracture, single or few pulmonary contusions or minimal pneumothorax) is still unclear. We compared efficacy and cost-effectiveness of a new clinical pathway involving an Emergency Department Observation Unit (EDOU) with routine care.
Design: Retrospective before-after study.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!