I work in a very small rural hospital. . . and we're getting smaller!!! We're in the process of combining the med/surg unit and the ICU/CCU unit so that it's all basically one unit on the same floor. Modifications are being made so that there will be four dedicated ICU/CCU type rooms with all of the monitoring devices, etc. The hospital is also having (finally!!!) real telemetry devices so that telemetry-type patients can walk untethered and still be monitored. (Currently, the ICU/CCU lacks the tele-packs so that a telemetry patient has to be hooked up to a monitor at all times.) I believe that an additional five or so tele beds will be made available on this combined med/surg/ICU/CCU floor. Total beds will be 15!!! (This is being done in order to qualify to receive special funding which, apparently, will mean more money than what the hospital is already receiving in reimbursements. . . .I don't know. . . . I'm just a staff nurse. . . .)
In actuality, most patients admitted to our happy little unit are telemetry-type patients. They're usually older patients with a new onset of a-fib or had a syncopal or near-syncopal episode etc. Another large population of patients are the "rule-out MI's". They are currently admitted as CCU patients until they either rule-out or remain a CCU patient if they do indeed rule-in.
The question has been raised as to whether "rule-out" patients should be - could be - admitted as telemetry patients until they either rule-in, in which case they would become CCU patients, or rule-out and either remain as telemetry patients for further cardiac-stress testing or go home with something to help their GERD. Actually, my nurse-manager has asked me to seek input from other ICU/CCU nurses who work in similar small-hospital situations and ask, "How do you classify your 'Rule-Out MI' patients when admitted to your hospital?".
O. K. . . . all you small-rural-community hospital type nurses (who may or may not work in the CCU/ICU). . . . I'm asking!
What is your policy regarding admitting patients with the diagnosis of "Rule Out MI"? Are they considered CCU patients or are they considered telemetry patients?
My personal opinion. . . . I think they should remain catagorized as CCU patients. What if they are admitted as telemetry patients, then rule-in as positive for an MI which would currently make them CCU patients (and are not shipped out to a bigger hospital which does cardiac caths, etc!) and all of the four ICU/CCU beds are full with real ICU/CCU patients?????
Thank you ahead of time for your thoughtful input and suggestions.
Sep 26, '02
I also work in a small rural hospital.
We admit R/O MI patients to our Med/Surg floor on telemetry if they are pain free and their first set of cardiac enzymes are normal as well as their EKG. If their status changes, they start to have pain or their enzymes go up or their EKG changes, they will go to ICU or transferred to a larger facility for an angiogram. We will not do Nitro drips on med/surg. We will however do IV amiodorone and IV Cardizem on Med/Surg for atrial fibrillation.
Last edit by willie2001 on Sep 26, '02