Coronary care unit triage decision aids: how do we known when they work?
Article Abstract:
Since acute myocardial infarction (heart attack) is the leading cause of death in this country, it is essential that hospitals have accurate means of triaging patients (classifying patients according to the severity of their disease) so that resources are used appropriately. Triage takes place in the Emergency Room and distinguishes between those patients who have serious heart problems and need to be admitted to the Coronary Care Unit (CCU) and those who have chest pains, but who do not have serious heart problems. Accuracy and speed in diagnosis and triage are essential, not only for satisfactory patient care, but also for proper utilization of hospital facilities. In this respect, the use of explicit criteria for admission to CCU, such as a CCU triage decision aid, can be very helpful. It can be difficult to determine which triage decision aid to choose for a particular clinical setting. In evaluating decision aids, those responsible for making a selection must consider the appropriateness for their clinical setting, safety and effectiveness in clinical trials and the likelihood of similar results in their clinical setting. Different triage decision aids have different uses and objectives: will it be used at the patient's initial presentation in the emergency room or after admission; does it focus on the likelihood of a diagnosis or on the complications of (in this case) infarction; will it be used to lead to a diagnosis, or will it help clinicians to carry out a specific treatment protocol? The selection of a decision aid will also depend on what problem it is to solve: are there unnecessary admissions to the CCU, or are high-risk patients not being admitted to CCU? After a decision aid has been selected and put into use in a clinical setting, it must be continually monitored and re-evaluated.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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Selecting the best triage rule for patients hospitalized with chest pain
Article Abstract:
More appropriate and efficient use of hospital beds in coronary care units (CCUs) may be achieved through the use of rules for triaging patients (categorizing according to the severity of their disease) from the emergency room to the CCU. In this observational study of 498 patients hospitalized with chest pain, two sets of triage rules were used. One set of rules applied to patients being admitted, to determine whether or not they would be admitted to the CCU or to the intermediate care unit (IC, monitored beds but a less intense level of care). The second set of rules, 'early transfer' rules, were applied 24 hours after admission to determine if it was appropriate to transfer patients to a non-monitored bed with less intense care. If the admission rules had been applied to these patients, CCU admissions would have increased by 3 percent. However, if the early transfer rules had been in effect, IC beds would have been reduced by 860 days per year and CCU beds by 82 days per year. The early transfer rule would also have reduced the CCU length of stay by 4 percent, the IC length of stay by 24 percent, and the total monitored bed (CCU and IC) length of stay by 17 percent. Application of the early transfer or 24 hour rule would have increased CCU and IC bed availability by 2.6 beds per day. The decreased length of stay in these special units not only improves hospital bed utilization by freeing up monitored beds, but also reduces the cost of hospitalization. For triage rules to be effective they must be realistic, reflect the actual practice of physicians and nursing staff, and take into consideration patient complications and other co-existing diagnoses.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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Using the patient's history to estimate the probability of coronary artery disease: a comparison of primary care and referral practices
Article Abstract:
The probability theory suggests that the interpretation of new information is based on the prior probability of disease. This theory is used as a guide for selecting and interpreting tests used to diagnose a disease. The usefulness of this theory in interpreting the history of a patient with chest pain was assessed. The prevalence of coronary artery disease, which affects the major blood vessels supplying the heart, was compared among patients with similar histories, but who were from populations with different disease prevalence. Two populations had a high disease prevalence and consisted of patients referred for coronary arteriography, the X-ray of the coronary arteries. Another two populations had a low disease prevalence and consisted of patients from primary care practices. The clinical characteristics of one of the populations containing patients referred for arteriography was used to estimate the probability of coronary artery narrowing, thereby relating clinical findings to the prevalence of coronary artery disease. The results show that coronary artery disease was less prevalent among primary care patients when compared with patients referred for arteriography, despite similarities in the clinical histories of the patients. Based on these findings, it is suggested that the clinician must consider the overall prevalence of a disease in a clinical setting when using patient histories to estimate the probability of the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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