 |
 |

How Do Physicians Adapt When the Coronary Care Unit Is Full?A Prospective Multicenter Study
Harry P. Selker, MD, MSPH;
John L. Griffith, MS;
Fredrick J. Dorey, PhD;
Ralph B. D'Agostino, PhD
JAMA. 1987;257(9):1181-1185.
Abstract
 |  |
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.
(JAMA 1987;257:1181-1185)
Author Affiliations
From the Multicenter Cardiology and Health Services Research Unit, formerly at Divisions of General Internal Medicine and Health Services Research, Departments of Medicine, UCLA and Cedars-Sinai Medical Centers, Los Angeles, and the Cardiology Department, Boston City Hospital; now at the Divisions of General Medicine and Clinical Decision Making, Department of Medicine, New England Medical Center Hospitals, Boston (Drs Selker, Dorey, and D'Agostino, and Mr Griffith); and the Department of Mathematics, Boston University (Dr D'Agostino and Mr Griffith). Dr Selker is an American College of Physicians Teaching and Research Scholar.
Footnotes
The opinions, conclusions, and proposals herein are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation.
Reprint requests to Multicenter Cardiology and Health Services Research Unit, New England Medical Center, 750 Washington St, Boston, MA 02111 (Dr Selker).
CiteULike Connotea Del.icio.us Digg Reddit Technorati Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Patients Readmitted to ICUs* : A Systematic Review of Risk Factors and Outcomes
Rosenberg and Watts
Chest 2000;118:492-502.
ABSTRACT
| FULL TEXT
Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature
Goodacre
Emerg. Med. J. 2000;17:1-6.
ABSTRACT
| FULL TEXT
Use of Intensive Care Units for Patients With Low Severity of Illness
Rosenthal et al.
Arch Intern Med 1998;158:1144-1151.
ABSTRACT
| FULL TEXT
The Use of Empiric Clinical Data in the Evaluation of Practice Guidelines for Unstable Angina
Katz et al.
JAMA 1996;276:1568-1574.
ABSTRACT
Prediction of the Need for Intensive Care in Patients Who Come to Emergency Departments with Acute Chest Pain
Goldman et al.
NEJM 1996;334:1498-1504.
ABSTRACT
| FULL TEXT
Ethical Considerations in the Allocation of Organs and Other Scarce Medical Resources Among Patients
Council on Ethical and Judicial Affairs, American et al.
Arch Intern Med 1995;155:29-40.
ABSTRACT
A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States
Rouleau et al.
NEJM 1993;328:779-784.
ABSTRACT
| FULL TEXT
The Health Care Resource Allocation Debate: Defining Our Terms
Hadorn and Brook
JAMA 1991;266:3328-3331.
ABSTRACT
One Year's Experience With a Noninvasively Monitored Intermediate Care Unit for Pulmonary Patients
Krieger et al.
JAMA 1990;264:1143-1146.
ABSTRACT
Early "Step-Down" Transfer of Low-Risk Patients with Chest Pain: A Controlled Interventional Trial
Weingarten et al.
ANN INTERN MED 1990;113:283-289.
ABSTRACT
Utilization Strategies for Intensive Care Units
Kalb and Miller
JAMA 1989;261:2389-2395.
ABSTRACT
The Early Effect of Medicare's Prospective Payment System on the Use of Medical Intensive Care Services in Three Community Hospitals
Mayer-Oakes et al.
JAMA 1988;260:3146-3149.
ABSTRACT
The Coronary Care Unit Turns 25: Historical Trends and Future Directions
LEE and GOLDMAN
ANN INTERN MED 1988;108:887-894.
ABSTRACT
|