COST-EFFECTIVENESS OF A NEW SHORT-STAY UNIT TO RULE OUT ACUTE MYOCARDIAL-INFARCTION IN LOW-RISK PATIENTS

Objectives. This study attempted to determine the safety and costs of a new short-stay unit for low risk patients who may be admitted to a h ospital to rule out myocardial infarction or ischemia. Background. One strategy to reduce the costs of ruling out acute myocardial infarctio n in low risk patients is to develop alternatives to coronary care uni ts. Methods. The short-term and 6-month clinical outcomes and costs fa r 592 patients admitted to a short-stay coronary observation unit at B righam and Women's Hospital with a low (less than or equal to 10%) pro bability of acute myocardial infarction were compared with those for 9 24 consecutive comparison patients who were eligible for the same unit but were admitted to other hospital settings or discharged home. Actu al costs were calculated using detailed cost-accounting methods that i ncorporated nursing intensity weights. Results. The rate of major comp lications, recurrent myocardial infarction or cardiac death during 6 m onths after the initial presentation of the 592 patients admitted to t he coronary obser- vation unit was similar to that of the 924 comparis on patients before and after adjustment for clinical factors influenci ng triage and initial diagnoses (adjusted relative risk 0.86, 95% conf idence interval 0.49 to 1.53). Their median total costs (25th, 75th pe rcentile) at 6 months ($1,927; 1,455, 3,650) were significantly lower than for comparison patients admitted to the wards ($4,712; 1,868, 11, 187), to stepdown or intermediate care units ($4,031; 2,069, 9,169) or to the coronary care unit ($9,201; 3,171, 20,011) but were higher tha n for comparison patients discharged home from the emergency departmen t ($403; 403, 927) before and after the same adjustments (all adjusted p < 0.0001). Conclusions. These data suggest that the coronary observ ation unit may be a safe and cost-saving alternative to current triage strategies for patients with a low risk of acute myocardial infarctio n admitted from the emergency department. Its replication in other hos pitals should be tested.