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Optimal use of coronary care units: a review
E W Grijseels1, J W Deckers, A W Hoes
1Department of General Practice, Erasmus University, Rotterdam, The Netherlands.
Insights
Managing chest pain patients efficiently requires alternatives to coronary care unit (CCU) admission. Strategies include home electrocardiograms, predictive models, and observation units for low-risk acute cardiac pathology patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Management
Background:
- A significant number of patients admitted to coronary care units (CCUs) have a low probability of acute cardiac pathology.
- Current management strategies for ruling out myocardial infarction may not be the most efficient for all patients.
Purpose of the Study:
- To review strategies for improving the efficiency of managing patients presenting with acute chest pain.
- To explore alternatives to CCU admission for low-risk patients.
Main Methods:
- Review of existing diagnostic algorithms and triage strategies.
- Discussion of predictive models incorporating laboratory assessments for emergency room identification of low-risk patients.
- Exploration of alternative care settings, such as observation units, for low-risk individuals.
Main Results:
- Development of algorithms for general practitioners, some requiring remote electrocardiogram monitoring.
- Identification of predictive models for emergency room triage of acute chest pain patients.
- Proposal of alternative care pathways, including observation units and early transfer from CCUs for low-risk patients.
Conclusions:
- A combination of improved diagnostic accuracy, efficient triage, and alternative care settings is most effective.
- The optimal strategy for managing acute chest pain patients depends on local healthcare circumstances and resources.
Abstract:
Patients at a low probability of acute cardiac pathology constitute a considerable proportion in many coronary care units (CCUs), such that physicians should consider more effective alternatives than CCU admission "to rule out myocardial infarction." In this article, strategies to increase the efficiency of managing patients with acute chest pain are reviewed. Algorithms aiming to improve the diagnostic accuracy of the general practitioner have been developed but require an electrocardiogram recorded at the home of the patient. Another method of triage encompasses the identification in the emergency room of the hospital of patients at a low probability of acute cardiac pathology by using predictive models that include laboratory assessments. A third strategy includes alternatives to CCUs for patients at a low risk of acute cardiac pathology, such as the creation of a simple observation unit. Finally, some investigators have sought to identify patients with good prognosis for early transfer from the CCU to lower levels of care. It is concluded that a combination of these approaches will be most efficient, and that the most appropriate choice will be determined by local circumstances.