Selecting the best triage rule for patients hospitalized with chest pain.
OBJECTIVE
During an observational study, we investigated the potential benefits and risks of the use of admission and early transfer triage rules in 498 patients hospitalized with chest pain.


METHODS
Appropriateness of triage decisions was measured using explicit and implicit judgments.


RESULTS
Application of an admission triage rule (partially based on the Brush electrocardiographic criteria) would have increased coronary care unit (CCU) admissions by 3%, whereas application of a triage rule 24 hours after admission would have reduced bed utilization by 860 intermediate care and 82 CCU bed-days per year when compared with actual patient triage. Although 9.5% of patients who underwent triage according to the early transfer triage rule would have experienced a minor complication after transfer, the medical care of none would have been adversely affected.


CONCLUSIONS
Our results show that application of a triage rule 24 hours after admission may have the potential to shorten length of stay in the CCU and intermediate care unit without significantly compromising patient care. However, use of the admission triage rule would have increased CCU bed utilization. The failure of the admission triage rule to improve bed utilization illustrates the potential hazards of ignoring patient complications, interventions, and co-morbidity when predicting the efficacy of a triage rule.
Weingarten
S R
SR
Department of Medicine, Cedars-Sinai Medical Center, U.C.L.A. School of Medicine 90048.
Ermann
B
B
Riedinger
M S
MS
Shah
P K
PK
Ellrodt
A G
AG
D000368:Aged; D000369:Aged, 80 and over; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007902:Length of Stay; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D014218:Triage / Q000458:organization & administration*