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Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges

INTRODUCTION: Emergency department (ED) cardioversion (EDCV) and discharge of patients with recent onset atrial fibrillation or atrial flutter (AF) has been shown to be a safe and effective management strategy. This study examines the impact of such aggressive ED management on hospital charges. METH...

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Detalles Bibliográficos
Autores principales: Sacchetti, Alfred, Williams, Jennifer, Levi, Steven, Akula, Devender
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582523/
https://www.ncbi.nlm.nih.gov/pubmed/23447757
http://dx.doi.org/10.5811/westjem.2012.1.6893
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author Sacchetti, Alfred
Williams, Jennifer
Levi, Steven
Akula, Devender
author_facet Sacchetti, Alfred
Williams, Jennifer
Levi, Steven
Akula, Devender
author_sort Sacchetti, Alfred
collection PubMed
description INTRODUCTION: Emergency department (ED) cardioversion (EDCV) and discharge of patients with recent onset atrial fibrillation or atrial flutter (AF) has been shown to be a safe and effective management strategy. This study examines the impact of such aggressive ED management on hospital charges. METHODS: A random sample of 300 AF patients were identified from an ED electronic data base and screened for timing of onset of their symptoms. Patients were considered eligible for EDCV if either nursing or physician notes documented an onset of symptoms less than 48 hours prior to ED presentation and the patient was less than 85 years of age. An explicit chart review was then performed to determine patient management and disposition. Cardioversion attempts were defined as ED administration of procainamide, flecainide, propafenone, ibutilide, amiodarone or direct current cardioversion (DCCV). Total hospital charges for each patient were obtained from the hospital billing office. Differences across medians were analyzed utilizing through Wilcoxon rank sum tests and chi square. RESULTS: A total of 51 patients were included in the study. EDCV was attempted on 24 (47%) patients, 22 (92%) were successfully cardioverted to normal sinus rhythm (NSR). An additional 12 (23%) spontaneously converted to NSR. Twenty (91%) of those successfully cardioverted were discharged from the ED along with 4 (33%) of those spontaneously converting. Pharmacologic cardioverson was attempted in six patients and was successful in three (50%), one after failed DCCV attempt. Direct current cardioversion was attempted in 21 (88%) and was successful in 19 (90%), two after failed pharmacologic attempts. Median charges for patients cardioverted and discharged from the ED were $5,460 (IQR $4,677–$6,190). Median charges for admitted patients with no attempt at cardioversion were $23,202 (IQR $19,663–$46,877). Median charges for patients whose final ED rhythm was NSR were $5,641 (IQR $4,638–$12,339) while for those remaining inAF median charges were $30,299 (IQR $20,655 – $69,759). CONCLUSION: ED cardioversion of recent onset AF patients results in significant hospital savings.
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spelling pubmed-35825232013-02-27 Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges Sacchetti, Alfred Williams, Jennifer Levi, Steven Akula, Devender West J Emerg Med Healthcare Utilization INTRODUCTION: Emergency department (ED) cardioversion (EDCV) and discharge of patients with recent onset atrial fibrillation or atrial flutter (AF) has been shown to be a safe and effective management strategy. This study examines the impact of such aggressive ED management on hospital charges. METHODS: A random sample of 300 AF patients were identified from an ED electronic data base and screened for timing of onset of their symptoms. Patients were considered eligible for EDCV if either nursing or physician notes documented an onset of symptoms less than 48 hours prior to ED presentation and the patient was less than 85 years of age. An explicit chart review was then performed to determine patient management and disposition. Cardioversion attempts were defined as ED administration of procainamide, flecainide, propafenone, ibutilide, amiodarone or direct current cardioversion (DCCV). Total hospital charges for each patient were obtained from the hospital billing office. Differences across medians were analyzed utilizing through Wilcoxon rank sum tests and chi square. RESULTS: A total of 51 patients were included in the study. EDCV was attempted on 24 (47%) patients, 22 (92%) were successfully cardioverted to normal sinus rhythm (NSR). An additional 12 (23%) spontaneously converted to NSR. Twenty (91%) of those successfully cardioverted were discharged from the ED along with 4 (33%) of those spontaneously converting. Pharmacologic cardioverson was attempted in six patients and was successful in three (50%), one after failed DCCV attempt. Direct current cardioversion was attempted in 21 (88%) and was successful in 19 (90%), two after failed pharmacologic attempts. Median charges for patients cardioverted and discharged from the ED were $5,460 (IQR $4,677–$6,190). Median charges for admitted patients with no attempt at cardioversion were $23,202 (IQR $19,663–$46,877). Median charges for patients whose final ED rhythm was NSR were $5,641 (IQR $4,638–$12,339) while for those remaining inAF median charges were $30,299 (IQR $20,655 – $69,759). CONCLUSION: ED cardioversion of recent onset AF patients results in significant hospital savings. Department of Emergency Medicine, University of California, Irvine School of Medicine 2013-02 /pmc/articles/PMC3582523/ /pubmed/23447757 http://dx.doi.org/10.5811/westjem.2012.1.6893 Text en Copyright © 2013 the authors. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Healthcare Utilization
Sacchetti, Alfred
Williams, Jennifer
Levi, Steven
Akula, Devender
Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges
title Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges
title_full Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges
title_fullStr Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges
title_full_unstemmed Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges
title_short Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges
title_sort impact of emergency department management of atrial fibrillation on hospital charges
topic Healthcare Utilization
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582523/
https://www.ncbi.nlm.nih.gov/pubmed/23447757
http://dx.doi.org/10.5811/westjem.2012.1.6893
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