Lengths of stay of patients with uncomplicated acute myocardial infarction at three Boston hospitals: impact of pre-discharge tactics.
Variability in length of stay (LOS) and its determinants were studied in 60 patients without complications after acute myocardial infarction (AMI) at three teaching hospitals. The patients at the three hospitals had similar clinical presentations and in-hospital courses. However, 81% of patients admitted to the intensive care unit (ICU) at one hospital were transferred to lower levels of care within 48 hours, compared with 40% and 56% at the other two hospitals (p less than 0.05). Patients who underwent pre-discharge exercise tests (ETT) had a longer total LOS than patients who did not (11.9 +/- 4.3 vs 9.2 +/- 2.9 days; p less than 0.01). Similarly, patients who underwent 24-hour ambulatory monitoring (AMB-MON) had a longer total LOS than patients who did not (12.3 +/- 4.3 vs 9.1 +/- 2.8 days; p less than 0.001). No differences in clinical characteristics or in survival at six months were detected between patients who did and did not undergo ETT or AMB-MON. Total LOS correlated with whether patients underwent 0, 1, or both of these tests (p less than 0.0001); each test was associated with a 2.3-day increase in the duration of hospitalization. The authors conclude that such tests may prolong total LOS of patients without complications after AMI.
Lee
T H
TH
Center for Cost-Effective Care, Brigham and Women's Hospital, Boston, MA 02115.
Gottlieb
L K
LK
Weitzman
L J
LJ
Mulley
A G
AG
Pauker
S G
SG
McNeil
B J
BJ
D001900:Boston; D003325:Coronary Care Units; D003365:Costs and Cost Analysis; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009203:Myocardial Infarction; D010351:Patient Discharge / Q000191:economics*; D010360:Patient Transfer