A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma

Background: Emergency diagnostic and treatment units (EDTUs) may provide all 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 late from the EDTU, length o f 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.