Feasibility of direct discharge from the coronary/intermediate care unit after acute myocardial infarction

OBJECTIVES This investigation was designed to determine the feasibility and cost-effectiveness of direct discharge from the coronary/intermediate care unit (CICU) in 497 consecutive patients with an acute myocardial infarction (AMI). BACKGROUND Although patients with an AMI are traditionally treated in the CICU followed by period on the medical ward, the latter phase can likely be incorporated within the CICU. METHODS All patients were considered for direct discharge from the CICU with appropriate patient education. The 6-week postdischarge course was evaluated using structured questionnaire by telephone interview. RESULTS There were 497 patients (men = 353; women = 144; age 63.5 ± 0.6 years) in the study, with 29 in-hospital deaths and further 11 deaths occurring within 6 weeks of discharge. The mode length of CICU stay was 4.0 days (mean 5.1 ± 0.2 days): 1 to 2 (12%), 3 (19%), 4 (21%), 5 (14%), 6 to 7 (19%) and ≥7 (15%) days, respectively with 87.2% discharged home directly. Of the 425 patients surveyed, 119 (28.0%) indicated that they had made unscheduled return visits (URV) to hospital or physician’s office: 10.6% to an emergency room, 9.4% to physician’s office and 8.0% readmitted to hospital. Of these URV, only 14.3% occurred within 48 h of discharge. Compared to historical controls, the present management strategy resulted in cost savings of Cdn. $4,044.01 per patient. CONCLUSIONS Direct discharge from CICU is feasible and safe strategy for the majority of patients that results in considerable savings.