Abstract
Background
Patients presenting to emergency departments (EDs) with acute atrial fibrillation
or flutter undergo numerous transitions in care (TiC), including changes in their
provider, level of care, and location. During transitions, gaps in communications
and care may lead to poor outcomes.
Objective
We sought to examine the effectiveness of ED-based interventions to improve length
of stay, return to normal sinus rhythm, and hospitalization, among other critical
patient TiC outcomes.
Methods
Comprehensive searches of electronic databases and the gray literature were conducted.
Two independent reviewers completed study selection, quality, and data extraction.
Relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects
model, where appropriate.
Results
From 823 citations, 11 studies were included. Interventions consisted of within-ED
clinical pathways (n = 6) and specialized observation units (n = 2) and post-ED structured
patient education and referrals (n = 3). Three of five studies assessing hospital
length of stay reported a significant decrease associated with TiC interventions.
Patients undergoing within-ED interventions were also more likely to receive electrical
cardioversion. Two of 3 clinical pathways reporting hospitalization proportions showed
significant decreases associated with TiC interventions (RR = 0.63 [95% CI 0.42–0.92]
and RR = 0.20 [95% CI 0.12–0.32]), as did 1 observation unit (RR = 0.54 [95% CI 0.36–0.80]).
No significant differences in mortality, complications, or relapse were found between
groupings among the studies.
Conclusions
There is low to moderate quality evidence suggesting that within-ED TiC interventions
may reduce hospital length of stay and decrease hospitalizations. Additional high-quality
comparative effectiveness studies, however, are warranted.
Keywords
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Article info
Publication history
Published online: September 19, 2019
Accepted:
June 4,
2019
Received in revised form:
May 14,
2019
Received:
February 27,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
