A Comparison Between Emergency Diagnostic and Treatment Unit and Inpatient Care in the Management of Acute Asthma

Michael F. McDermott, MD; Daniel G. Murphy, MD; Robert J. Zalenski, MD; Rober J. Rydman, PhD; Madeline McCarren, PhD; David Marder, MD; Borko Jovanovic, PhD; Kulvinder Kaur; Rebecca R. Roberts, MD; Miriam Isola, DrPH; Edward Mensah, PhD; Rosula Rajendran, MD; Linda Kampe, RRA
Arch Intern Med. 1997;157(18):2055-2062. doi:10.1001/archinte.1997.00440390041006.
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Background:  Emergency diagnostic and treatment units (EDTUs) may provide an alternative to hospitalization for patients with reversible diseases, such as asthma, who fail to adequately respond to emergency department therapy.

Objective:  To evaluate the medical and cost-effectiveness, patient satisfaction, and quality of life of patients receiving EDTU care for acute asthma compared with inpatient care.

Methods:  A prospective, randomized clinical trial performed at 2 urban public hospitals enrolled patients with acute asthma (age range, 18-55 years) not meeting discharge criteria after 3 hours of emergency department therapy. Patients were treated with inhaled adrenergic agonists and steroids in an EDTU for up to 9 hours after randomization or with routine therapy in a hospital ward. Patients were followed up for 8 weeks.

Main Outcome Measures:  Discharge rate from the EDTU, length of stay, relapse rates, days missed from work or school, days incapacitated during waking hours, symptom-free days and nights, nocturnal awakenings, direct medical costs, patient satisfaction, and patient quality of life.

Results:  The study consisted of 222 patients with asthma. Sixty-five patients (59%) treated in an EDTU were discharged home; the remainder were admitted to the hospital. There were no differences during the follow-up period in relapse rates (P=.74) or in any other morbidities between the EDTU and inpatient groups. There were significant differences in the length of stay, patient satisfaction, and quality of life favoring EDTU care. The mean (±SD) cost per patient in the EDTU group was $1202.79±$1343.96, compared with $2247.32±$1110.18 for the control group (P<.001).

Conclusions:  Treatment of selected patients with asthma in an EDTU results in the safe discharge of most such patients. This study suggests that quality gains and cost-effective measures can be achieved by the use of such units.Arch Intern Med. 1997;157:2055-2062


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