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Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care

Goodacre, S., Nicholl, J., Dixon, S., Cross, E., Angelini, K., Arnold, J., Revill, S., Locker, T., Capewell, S.J., Quinney, D., Campbell, S. and Morris, F. (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ, 328 (7434). pp. 254-257. ISSN 0959-8138

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Abstract

Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain. Design Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective. Setting The emergency department at the Northern General Hospital, Sheffield, United Kingdom. Participants 972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance. Main outcome measures The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service. Results Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, –7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of £78 per patient (–£56 to £210, P = 0.252). Conclusions Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care.

Item Type: Article
Copyright, Publisher and Additional Information: © BMJ 2004. Reproduced in accordance with the publisher's self-archiving policy.
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Depositing User: Repository Officer
Date Deposited: 12 Sep 2006
Last Modified: 06 Jun 2014 03:30
Published Version: http://bmj.com/cgi/content/full/328/7434/254
Status: Published
Publisher: British Medical Journal Publishing Group
Refereed: Yes
Identification Number: 10.1136/bmj.37956.664236.EE
URI: http://eprints.whiterose.ac.uk/id/eprint/1570

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