Holding Unit and ER Crowding: The Management of Acute Heart Failure

Acute heart failure (AHF) is one of the main causes of hospitalization in Western countries; it is estimated to account for about 1¿2% of visits to the emergency department (ED). Approximately 70¿80% of ED patients with AHF have clinical indications for hospitalization. AHF accounts for 10% of hospitalized patients. Heart failure patients have higher rates of readmission and ED revisitation than other patients. The ED not only plays an important role in returning patients after an inpatient discharge, but can also prevent the need for a longer inpatient stay for well-timed visits. Holding units are clinical decision units, or observation units, within the ED, they are able to alleviate access block and ED overcrowding. They also contribute to a reduction in hospitalization and improvements in ambulatory care.In our ER in response to the problem of crowding and access block, it was decided to set up a team of capable and experienced physicians to form the decision unit of our ER and be dedicated to the holding area, called brief intensive observation (OBI).This study aimed to investigate whether OBI admission was associated with a significantly higher rate of patient stabilization.