Coronary care units (CCUs) are uniquely designed and staffed to care for critically ill patients with cardiovascular disease, whereas medical intensive care units (MICUs) are specially organized and staffed for the care of patients with noncardiovascular critical illness. The demand for intensivist‐staffed MICU beds often exceeds the availability. As a result, during times of MICU bed unavailability, some patients with noncardiovascular critical illness are triaged to a cardiology‐staffed CCU in order to deliver intensive care in a timely manner. The impact of this strategy on patient outcomes is unknown.
Using a hospital administrative database, we performed a retrospective analysis of all patients admitted to the CCU with a noncardiovascular primary diagnosis between May 1, 2004, and April 30, 2008. This group of 312 patients was compared to a similar group of 863 patients admitted to the MICU during the same period. Patient demographics, admission diagnosis, length of stay, read‐mission rate, and hospital mortality were analyzed. Groups were compared using the Student t test, the Wilcoxon rank sum test, and the chi‐square test when appropriate.
Patients admitted to the CCU were older (60 ± 18 vs. 57 ± 18 years); otherwise both groups were similar in sex, race, and distribution of noncardiovascular ICD‐9 admission diagnoses. Median length of stay was 9 days (Cl 8–10 days) for both groups (P = 0.70.) There were 157 deaths (18.2%) in the ICU group and 62 deaths (19.2%) in the CCU group (P = 0.51), and there was no significant difference in the 30 day readmission rate between both groups (23.4% vs. 28.4%; P = 0.11). Comparison of each ICD‐9 diagnosis subset showed no significant difference in any patient outcome.
During times of MICU bed unavailability, a triage policy that directs critically ill, noncardiovascular patients to a CCU instead of a MICU does not appear to adversely affect length of stay, readmission rate, or patient survival. In an environment of constrained MICU bed access, the use of CCU bed resources as an alternative for the delivery of noncardiovascular critical care might be an acceptable policy.
V. Aggarwal, none; M. Grushko, none; R. Sidlow, none; Rabin Rahmani, none.