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
- 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.
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)
Footnotes
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The opinions, conclusions, and proposals herein are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation.
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Reprint requests to Multicenter Cardiology and Health Services Research Unit, New England Medical Center, 750 Washington St, Boston, MA 02111 (Dr Selker).
