title: It is safe to manage selected patients with acute coronary syndromes in unmonitored beds.
abstract: This prospective, observational study evaluated the safety of the Western Hospital admission protocol for patients with suspected acute coronary syndromes. The study included all patients admitted from the Emergency Department with an admission diagnosis of unstable angina, post infarct angina, atypical chest pain, or chest pain for evaluation. Data collected included demographic data, admission diagnosis, location of admission (bed with or without cardiac monitoring), past medical history and presenting chest pain history to determine Agency for Health Care Policy (AHCPR) and Western Hospital (WH) protocol classifications, cardiac enzyme assays, electrocardiogram analysis, adverse outcomes [death, myocardial infarction (MI), dysrhythmia, acute pulmonary edema, recurrent pain], diagnosis at hospital discharge, and length of stay-(LOS). There were 508 patients with a mean age of 63.7 years enrolled in the study. Three hundred nineteen (62.8%) were admitted to beds without any cardiac monitoring. There was one unexpected death in the unmonitored group, an 85 year-old patient who suffered a presumed dysrhythmia and whom the treating physician had decided was not for resuscitation. Twelve patients suffered nonfatal MI, and none suffered pulmonary edema. All MI patients made an uneventful recovery, and none required thrombolysis. If all patients had been admitted to an area of care based on AHCPR guidelines, an additional 310 admissions to monitored beds would have been required. The results of this study suggest that selected patients with suspected acute coronary syndromes can be safely managed in beds without continuous cardiac monitoring.
authors.affiliation: Department of Emergency Medicine, Western Hospital, 3011, Footscray, Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Kelly
authors.forename: D
authors.initials: D
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000628:therapy*; D001315:Australia; D002985:Clinical Protocols; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017202:Myocardial Ischemia / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D017751:Safety Management; D013577:Syndrome