A minority (~15%) of initially stable patients with NSTEMI will develop complications mandating management in an intensive care unit (ICU), but the majority of patients will remain stable throughout their hospital course. Due to this risk of clinical deterioration, Duke University Hospital admits all patients presenting to the emergency department (ED) or transferring from an outside hospital with non-ST segment elevation myocardial infarction (NSTEMI) to the cardiac intensive care unit (CICU), even those that are clinically stable. The CICU is optimized to care for critically ill patients rather than for efficiency and patient through-put, and admitting all patients with stable NSTEMI to the CICU is likely to increase hospital costs and may delay cardiac catheterization and discharge.

We have developed a risk score that uses clinical data gathered during the initial ED evaluation to predict the development of in-hospital complications requiring ICU care in initially stable patients with NSTEMI. This pilot proposes to integrate this risk score into MaestroCare to deliver prognostic information to ED providers, and to use a threshold value to determine whether patients should be triaged to stepdown or the CICU.