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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Impact of an Emergency Department Observation Unit Transient Ischemic Attack Protocol on Length of Stay and Cost
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Impact of an Emergency Department Observation Unit Transient Ischemic Attack Protocol on Length of Stay and Cost

机译：应急部门观测单位瞬态缺血攻击协议对留守率和成本长度的影响

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This study examined the impact of an emergency department (ED) observation unit's accelerated diagnostic protocol (ADP) on hospital length of stay (LOS), cost of care, and clinical outcome of patients who had sustained a transient ischemic attack (TIA). All patients with TIA presenting to the ED over a 18-consecutive month period were eligible for the study. During the initial 11 months of the study (pre-ADP period), all patients were admitted to the neurology service. Over the subsequent 7 months (post-ADP period), patients were either managed using the ADP or were admitted based on ADP exclusion criteria or at a physician's discretion. All patients had orders for serial clinical examinations, neurologic evaluation, cardiac monitoring, vascular imaging of the brain and neck, and echocardiography. A total of 142 patients were included in the study (mean age, 67.9 ± 13.9 years; 61% female; mean ABCD2 score, 4.3 ± 1.4). In the post-ADP period, 68% of the patients were managed using the ADP. Of these patients, 79% were discharged with a median LOS of 25.5 hours (ED + observation unit). Compared with the pre-ADP patients, the post-ADP patients (ADP and non-ADP) had a 20.8-hour shorter median LOS (95% confidence interval, 16.3-25.1 hours; P < .01) than pre-ADP patients and lower median associated costs (cost difference, $1643; 95% confidence interval, $1047-$2238). The stroke rate at 90 days was low in both groups (pre-ADP, 0%; post-ADP, 1.2%). Our findings indicate that introduction of an ED observation unit ADP for patients with TIA at a primary stroke center is associated with a significantly shorter LOS and lower costs compared with inpatient admission, with comparable clinical outcomes.
机译：本研究审查了应急部门（ED）观察单位加速诊断议定书（ADP）对医院住院时间（LOS）的影响，护理费用和持续瞬态缺血性攻击（TIA）的临床结果的影响。所有TIA的患者连续18个月期间呈现给ED，有资格参加该研究。在研究的最初11个月（ADP期间），所有患者均被录取为神经病学服务。在随后的7个月（ADP后期），患者使用ADP进行管理，或者根据ADP排除标准或医生自行决定进行管理。所有患者均有序列临床检查，神经系统评估，心脏监测，脑和颈部的血管成像以及超声心动图。研究中共有142名患者（平均年龄，67.9±13.9岁; 61％的女性;平均ABCD2得分，4.3±1.4）。在ADP后期，68％的患者使用ADP进行管理。在这些患者中，79％的排出量为25.5小时（ED +观察单元）。与阿达普前患者相比，ADP后患者（ADP和非ADP）具有20.8小时较短的中位数洛杉矶（95％置信区间，16.3-25.1小时; P <.01）比ADP患者和患者中位数相关成本（成本差异，1643美元; 95％置信区间，1047-2238美元）。两组中90天的行程率低（ADP前，0％; ADP后，1.2％）。我们的研究结果表明，在初级行程中心的TIA患者中引入ED观察单元ADP与Inpatient入院相比，与入围性录取相比，洛杉矶和降低成本明显较短，具有可比的临床结果。

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