Objectives To measure the effectiveness and cost effectiveness\ud of providing care in a chest pain observation unit compared\ud with routine care for patients with acute, undifferentiated chest\ud pain.\ud Design Cluster randomised controlled trial, with 442 days\ud randomised to the chest pain observation unit or routine care,\ud and cost effectiveness analysis from a health service costing\ud perspective.\ud Setting The emergency department at the Northern General\ud Hospital, Sheffield, United Kingdom.\ud Participants 972 patients with acute, undifferentiated chest\ud pain (479 attending on days when care was delivered in the\ud chest pain observation unit, 493 on days of routine care)\ud followed up until six months after initial attendance.\ud Main outcome measures The proportion of participants\ud admitted to hospital, the proportion with acute coronary\ud syndrome sent home inappropriately, major adverse cardiac\ud events over six months, health utility, hospital reattendance and\ud readmission, and costs per patient to the health service.\ud Results Use of a chest pain observation unit reduced the\ud proportion of patients admitted from 54% to 37% (difference\ud 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65,\ud P < 0.001) and the proportion discharged with acute coronary\ud syndrome from 14% to 6% (8%, –7% to 23%, P = 0.264). Rates\ud of cardiac event were unchanged. Care in the chest pain\ud observation unit was associated with improved health utility\ud during follow up (0.0137 quality adjusted life years gained, 95%\ud confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of\ud £78 per patient (–£56 to £210, P = 0.252).\ud Conclusions Care in a chest pain observation unit can improve\ud outcomes and may reduce costs to the health service. It seems\ud to be more effective and more cost effective than routine care
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