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CLINICAL STUDIES

Feasibility of direct discharge from the coronary/intermediate care unit after acute myocardial infarction

^a Division of Cardiac Sciences, Grey Nuns Hospital, Edmonton, Alberta, Canada

Manuscript received June 11, 1998; revised manuscript received October 20, 1998, accepted December 17, 1998.

Reprint requests and correspondence: Dr. M. P. J. Senaratne, Associate Clinical Professor of Medicine, University of Alberta, Director Coronary Care Unit, Grey Nuns Hospital, 1100 Youville Drive West, Edmonton, Alberta, T6L 5X8 Canada

OBJECTIVES

This investigation was designed to determine the feasibility and cost-effectiveness of direct discharge from the coronary/intermediate care unit (CICU) in 497 consecutive patients with an acute myocardial infarction (AMI).

BACKGROUND

Although patients with an AMI are traditionally treated in the CICU followed by a period on the medical ward, the latter phase can likely be incorporated within the CICU.

METHODS

All patients were considered for direct discharge from the CICU with appropriate patient education. The 6-week postdischarge course was evaluated using a structured questionnaire by a telephone interview.

RESULTS

There were 497 patients (men = 353; women = 144; age 63.5 ± 0.6 years) in the study, with 29 in-hospital deaths and a further 11 deaths occurring within 6 weeks of discharge. The mode length of CICU stay was 4.0 days (mean 5.1 ± 0.2 days): 1 to 2 (12%), 3 (19%), 4 (21%), 5 (14%), 6 to 7 (19%) and 7 (15%) days, respectively with 87.2% discharged home directly. Of the 425 patients surveyed, 119 (28.0%) indicated that they had made unscheduled return visits (URV) to a hospital or physician’s office: 10.6% to an emergency room, 9.4% to a physician’s office and 8.0% readmitted to a hospital. Of these URV, only 14.3% occurred within 48 h of discharge. Compared to historical controls, the present management strategy resulted in a cost savings of Cdn. $4,044.01 per patient.

CONCLUSIONS

Direct discharge from CICU is a feasible and safe strategy for the majority of patients that results in considerable savings.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CICU = coronary/intermediate care unit   ECG = electrocardiogram, electrocardiographic   LD = lactate dehydrogenase   URV = unscheduled return visits

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