A study of unplanned readmissions to a coronary care unit.
OBJECTIVE
To determine the cause and frequency of unplanned readmissions to a coronary care unit (CCU) after initial transfer to a general cardiac unit, but before hospital discharge.


METHODS
Analysis of 1776 admissions to a CCU during a 16-month period.


METHODS
The CCU of a major teaching hospital in South Australia.


METHODS
All patients admitted to the CCU during the 16-month period.


METHODS
CCU readmissions before hospital discharge were categorized as either "planned" or "unplanned." The latter were investigated for determination of casualty and variations in patient characteristics (including age, sex, initial diagnosis, pharmacotherapy, and duration of stay in the CCU).


RESULTS
Of the 1776 CCU admissions examined, 44 (2.5% of total) were unplanned readmissions before hospital discharge. Most of these (39 of 44) were related to "reactivation" of acute myocardial ischemia. Patients whose initial diagnosis was acute myocardial infarction or unstable angina pectoris were more likely to require a further unplanned CCU admission (p < 0.05); those with unstable angina pectoris had a second stay in CCU significantly longer than their first (p < 0.05). Six patients were readmitted within 6 hours of cessation of a heparin infusion (4 of the 6 without aspirin administration), and 11 patients had not received antiplatelet therapy after their initial CCU stay. Overall, a disproportionate number of men were readmitted to CCU (p < 0.05).


CONCLUSIONS
In the current study, unplanned readmissions to the CCU: (1) were relatively infrequent, (2) were more protracted than initial stays in CCU, (3) may have been prevented in 15 of the 44 cases with more appropriate pharmacotherapy, and (4) involved a disproportionate number of male patients.
Stewart
S
S
Department of Cardiology, Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia.
Voss
D W
DW
D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000453:epidemiology*; D001241:Aspirin / Q000008:administration & dosage; D015984:Causality; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology*; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D013021:South Australia / Q000453:epidemiology; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin