A STUDY OF UNPLANNED READMISSIONS TO A CORONARY-CARE UNIT

OBJECTIVE: To determine the cause and frequency of unplanned readmissi ons to a coronary care unit (CCU) after initial transfer to a general cardiac unit, but before hospital discharge. DESIGN: Analysis of 1776 admissions to a CCU during a 16-month period. SETTING: The CCU of a ma jor teaching hospital in South Australia. PARTICIPANTS: All patients a dmitted to the CCU during the 16-month period. OUTCOME MEASURES: CCU r eadmissions before hospital discharge were categorized as either ''pla nned'' or ''unplanned.'' The latter were investigated for determinatio n of causality and variations in patient characteristics (including ag e, sex, initial diagnosis, pharmacotherapy, and duration of stay in th e CCU). RESULTS: Of the 1776 CCU admissions examined, 44 (2.5% of tota l) were unplanned readmissions before hospital discharge. Most of thes e (39 of 44) were related to ''reactivation'' of acute myocardial isch emia. Patients whose initial diagnosis was acute myocardial infarction or unstable angina pectoris were more likely to require a further unp lanned 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. Ov erall, a disproportionate number of men were readmitted to CCU (p<0.05 ). CONCLUSIONS: In the current study, unplanned readmissions to the CC U: (1) were relatively infrequent, (2) were more protracted than initi al stays in CCU, (3) may have been prevented in 15 of the 44 cases wit h more appropriate pharmacotherapy, and (4) involved a disproportionat e number of male patients.