It is safe to manage selected patients with acute coronary syndromes in unmonitored beds

This prospective, observational study evaluated the safety of the Western H ospital admission protocol for patients with suspected acute coronary syndr omes. The study included all patients admitted from the Emergency Departmen t with an admission diagnosis of unstable angina, post infarct angina, atyp ical chest pain, or chest pain for evaluation. Data collected included demo graphic data, admission diagnosis, location of admission (bed with or witho ut cardiac monitoring), past medical history and presenting chest pain hist ory to determine Agency for Health Care Policy (AHCPR) and Western Hospital (WH) protocol classifications, cardiac enzyme assays, electrocardiogram ana lysis, adverse outcomes [death, myocardial infarction (MI), dysrhythmia, ac ute 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 bed s without any cardiac monitoring. There was one unexpected death in the unm onitored group, an 85 year-old patient who suffered a presumed dysrhythmia and whom the treating physician had decided was not for resuscitation. Twel ve patients suffered nonfatal MI, and none suffered pulmonary edema. All MI patients made an uneventful recovery, and none required thrombolysis. If a ll patients had been admitted to an area of care based on AHCPR guidelines, an additional 310 admissions to monitored beds would have been required. T he results of this study suggest that selected patients with suspected acut e coronary syndromes can be safely managed in beds without continuous cardi ac monitoring. (C) 2001 Elsevier Science Inc.