How do physicians adapt when the coronary care unit is full? A prospective multicenter study
H. P. Selker, J. L. Griffith, F. J. Dorey and R. B. D'Agostino
Reducing the numbers of coronary care unit (CCU) beds would decrease
expensive unnecessary admissions, but might also block appropriate
admissions. To study how physicians adapt to limited CCU beds, we compared
their decisions to admit patients to the CCU when the CCU was full with
those made when the CCU was not full. We studied 4479 patients who
presented with symptoms suggesting acute cardiac ischemia to six New
England hospital emergency rooms over 16 months. Of the 2931 patients found
on follow-up not to have acute ischemia, 33% of those presenting when the
CCU was not full were admitted to the CCU vs 24% of such patients
presenting when the CCU was full (P = .0005), a 27% drop. Of the 725
patients proving to have angina pectoris, 74% of those presenting when the
CCU was not full were admitted to the CCU vs 62% of such patients
presenting when the CCU was full (P = .007), a 16% reduction. Of the 823
patients found to have myocardial infarction, 90% were admitted to the CCU
both when the CCU was not full and when it was full. Importantly, for no
group did mortality increase when the CCU was full. These data suggest that
physicians can safely adapt to substantial reductions in the availability
of CCU beds.
