Effective Observation Unit Treatment of Decompensated Heart Failure

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Abstract
There is little information on the effectiveness of emergency department (ED) observation unit (OU) heart failure (HF) therapy. The authors' objective was to evaluate outcomes after implementation of an ED‐OU treatment protocol for HF exacerbation. Unblinded assessment of the effectiveness of an HF protocol was performed, controlled by outcome for 9 months prior to implementation. This included diagnostic and therapeutic algorithms, cardiology consultation, close monitoring, patient education, and discharge planning. Adverse outcomes were defined as the 90‐day rates of ED HF revisits, hospital HF readmissions, or death, as determined by chart review, computer database search, and phone follow‐up. One hundred fifty‐four patients were enrolled; 50 entered before, and 104 after protocol implementation. Only six (12%) in the preprotocol and one (1%) of the post protocol group were lost to follow‐up. After an OU visit, post protocol 90‐day ED HF revisit rates declined 56% (0.90–0.51; p