Abstract 16112: In Hospital Triage of ST Segment Myocardial Infarction Patients Results in Favorable Clinical Outcomes and Reduced ICU and Overall Hospital Length of Stay
Introduction: The conventional length of stay after ST-segment elevation myocardial infarction (STEMI) was 7-10 days in the thrombolytic era. Data on optimal length of hospital stay in patients undergoing primary percutaneous coronary intervention for STEMI is limited. Current practice at our academic institution has been to admit all STEMI patients to intensive care unit (ICU) status. Using predefined criteria, we evaluated the feasibility and safety of initial triage of STEMI patients to intermediate care (IMC) status instead of the default ICU status.
Methods: Twelve general cardiology fellows triaged all patients presenting with STEMI from 8/10/2015 through 4/30/2016 to either IMC or ICU status. The average nurse to patient ratio is 1:2 for ICU status and 1:4 for IMC status. Criteria for IMC admission included successful revascularization, hemodynamic stability, and absence of major arrhythmias. Triage status and clinical findings were documented with a standard note template in the electronic medical record. In-hospital complications were defined as death, reinfarction, non-fatal stroke, new heart failure or cardiogenic shock, new arrhythmia, and bleeding.
Results: A total of 122 STEMI patients underwent triage. Ninety patients (74%) were triaged to ICU status and 32 patients (26%) were triaged to IMC status. The number of patients with any complication was 29/90 (33%) in the ICU group vs. 3/32 (9%) in the IMC group (p=0.012). There was a total of 60 complications in the ICU group vs. 3 complications in the IMC group. In-hospital mortality was 6/90 (7%) in the ICU group vs. 0/32 (0%) in the IMC group (p=0.34). The majority of arrhythmias were atrial fibrillation or flutter. In the IMC group, bleeding complications included hematoma or access site bleeding. The median length of stay was 4 days (range 2-30 days). Hospital stay was shorter in the IMC group (median of 3 days, vs. 4 days in the ICU group, p=0.004). Seven patients in the IMC group stayed for as short as 2 days.
Conclusions: STEMI patients triaged to IMC status had fewer complications and a shorter length of stay than STEMI patients triaged to ICU status. Initial triage of uncomplicated STEMI patients to IMC status is safe and feasible. This has the potential to reduce cost and optimize resource utilization.
Author Disclosures: N.M. Reilly: None. S.I. Gunnarsson: None. B. Ciske: None. S. Saari: None. M. Leal: None. A. Raval: None. A. O’Connor: None.
- © 2016 by American Heart Association, Inc.