PII S0736-4679(01)00374-2 Original Contributions IT IS SAFE TO MANAGE SELECTED PATIENTS WITH ACUTE CORONARY SYNDROMES IN UNMONITORED BEDS Anne-Maree Kelly, MD, MBBS, MclinEd, FACEM, and Debra Kerr, RN, Cert CCU Nursing, BN, GDBM–Health Department of Emergency Medicine, Western Hospital, Footscray, Australia 3011 Reprint Address: Anne-Maree Kelly, MD, MBBS, MclinEd, FACEM, Department of Emergency Medicine, Western Hospital, Private Bag, Footscray 3011, Australia e Abstract—This prospective, observational study evalu- ated the safety of the Western Hospital admission protocol for patients with suspected acute coronary syndromes. The study included all patients admitted from the Emergency Department with an admission diagnosis of unstable an- gina, post infarct angina, atypical chest pain, or chest pain for evaluation. Data collected included demographic data, admission diagnosis, location of admission (bed with or without cardiac monitoring), past medical history and pre- senting chest pain history to determine Agency for Health Care Policy (AHCPR) and Western Hospital(WH) protocol classifications, cardiac enzyme assays, electrocardiogram analysis, adverse outcomes [death, myocardial infarction (MI), dysrhythmia, acute 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 beds without any cardiac moni- toring. There was one unexpected death in the unmonitored group, an 85 year-old patient who suffered a presumed dysrhythmia and whom the treating physician had decided was not for resuscitation. Twelve patients suffered nonfatal MI, and none suffered pulmonary edema. All MI patients made an uneventful recovery, and none required thrombol- ysis. If all patients had been admitted to an area of care based on AHCPR guidelines, an additional 310 admissions to monitored beds would have been required. The results of this study suggest that selected patients with suspected acute coronary syndromes can be safely managed in beds without continuous cardiac monitoring. © 2001 Elsevier Science Inc. e Keywords—acute coronary syndrome; chest pain; an- gina; admission protocol INTRODUCTION In most Australian hospitals, it is the usual practice to admit patients suffering suspected acute coronary syn- dromes (ACS), such as unstable angina, to areas of care that have continuous cardiac monitoring such as coro- nary care units (CCU). The rationale for this approach is predicated on the assumption that the benefits afforded by cardiac monitoring to patients with myocardial infarc- tion (MI) also apply to those with ACS. Although this assumption has not been confirmed by research, the requirement for cardiac monitoring for patients with sus- pected ACS has been reinforced by the Agency for Health Care Policy and Research (AHCPR, USA) and the National Health and Medical Research Council (Aus- tralia) guidelines on the management of unstable angina (1,2). This practice places significant stress on a limited number of monitored beds, has proven to be costly, and may result in admission delays (or on occasion, transfer between hospitals) for patients with proven MI (3). Recent studies from the United States have shown that a subgroup of patients with ACS can be safely managed in telemetry areas and have questioned the need for monitored beds for these patients (4). In 1997, in response to problems accessing CCU beds Original Contributions is coordinated by John A. Marx, MD, of Carolinas Medical Center, Charlotte, North Carolina RECEIVED: 22 June 2000; FINAL SUBMISSION RECEIVED: 11 February 2000; ACCEPTED: 16 January 2001 The Journal of Emergency Medicine, Vol. 21, No. 3, pp. 227–233, 2001 Copyright © 2001 Elsevier Science Inc. Printed in the USA. All rights reserved 0736-4679/01 $–see front matter 227