Table 3. Definition of unstable angina care environments

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                 Emergency Department (ED)
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To be considered an adequate ED for patients with unstable
angina, a hospital or clinic entry point or emergency chest
pain center should be continuously staffed by
personnel competent in performing an ECG, initial
evaluation and treatment of patients with unstable angina,
cardiac monitoring, and advanced cardiac life support (ACLS).
Such a facility should be able to provide routine laboratory
testing and radiographic studies. In remote regions of
the country, where continuous availability of trained
personnel is not feasible, arrangement of consultation
linkages with practitioners with appropriate training using
facsimile and telephone communication is recommended.
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                    Outpatient Facility
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A doctor's office, hospital associated or free-standing
clinic, or other environment to be used for care of patients
initially presenting with symptoms of unstable angina who
are not hospitalized should have the capability to perform a
12-lead ECG and be staffed by personnel who are competent in
placing a secure IV line and performing basic life support
(BLS).  
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                   Intensive Care Unit (ICU)
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This unit, which may also be called a coronary care unit
(CCU), represents the highest level of medical intensive care
available in a hospital. Typical characteristics include a nurse
to patient ratio of 1:1 or 1:2; cardiac monitoring; immediate
access to persons trained in ACLS; and capabilities for
arterial line and pulmonary artery catheter placement,
temporary pacemaker placement, and mechanical ventilation.
Some, but not all, such units will have facilities for intra-
aortic balloon placement. This unit can handle all forms of
vasoactive continuous IV infusion. Nurses are competent
in the recognition and treatment of arrhythimias and evaluation
of ischemic symptoms.
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                    Intermediate Care Unit
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This unit, which may also be referred to as a cardiac
monitoring or step-down unit, has a lower nurse to patient
ratio, typically 1:3 to 1:5, than an ICU. It can provide
continuous ECG monitoring and prompt access to personel
trained in ACLS. Personnel are competent in recognition of
arrhythmias and evaluation of ischemic symptoms. Patients on
some forms of vasoactive drips (e.g., low dose dopamine,
dobutamine, or nitroglycerin [NTG] infusion) or with a
temporary pacemaker already in place may be cared for in this
unit.
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                   Standard Hospital Unit
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A standard hospital unit typically has a nurse to patient
ratio greater than 1:5.  ECG telemetry may or may not be
available, but the nurses must be competent in recognition of
unstable angina and its initial management. Access to cardiac
resuscitation is via a code cart on the floor and a designated
code team. Nursing personnel on the floor are trained in BLS.
Continuous heparin infusions may be used, but usually vasoactive
drug infusions are not permitted.