 |
 |
|
|
|  PubMed
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 February 1994 | Volume 120 Issue 4 | Pages 257-263
Objective: The acceptability, safety, and efficacy of practice guidelines have rarely been evaluated. Moreover, despite the recent development of guidelines and decision aids for patients admitted to coronary care and intermediate care units, few have been tested in clinical practice.
Design: A prospective, controlled clinical trial with an alternate-month design.
Setting: A large teaching community hospital.
Patients: Patients admitted to coronary care and intermediate care units with chest pain who were considered at low risk for complications according to a practice guideline (n = 375).
Intervention: Physicians caring for patients with chest pain who were at low risk for complications received concurrent, personalized written and verbal reminders regarding a guideline that recommended a 2-day hospital stay.
Results: Use of the practice guideline recommendation with concurrent reminders was associated with a 50% to 69% increase in guideline compliance (P < 0.001) and a decrease in length of stay from 3.54 ±4.1 to 2.63 ±3.0 days (0.91-day reduction, 95% CI, 0.18 to 1.63; P = 0.02) for all patients with chest pain considered at low risk for complications. The intervention was associated with a total (direct and indirect) cost reduction of $1397 per patient (CI, $176 to $2618; P = 0.03). No significant difference was found in the hospital complication rate between patients admitted to the hospital during control and intervention periods, and no significant difference was noted in complications, patient health status, or patient satisfaction when measured 1 month after hospital discharge.
Conclusion: These results suggest that implementation of this practice guideline through concurrent reminders reduced hospital costs for patients with chest pain considered at low risk for complications. Further study of the guideline is warranted.
Author and Article Information
From the Cedars-Sinai Medical Center, Los Angeles, California; Brigham and Women's Hospital, Boston, Massachusetts.
ARTICLE
Practice Guidelines and Reminders to Reduce Duration of Hospital Stay for Patients with Chest Pain: An Interventional Trial
Requests for Reprints: Scott Weingarten, MD, Cedars-Sinai Medical Center, Department of Medicine, Becker 146, 8700 Beverly Boulevard, Los Angeles, CA 90048.
Acknowledgments: The authors thank Liz Gaddey, RN, Sylvia George, RN, Donald Hoytt, MD, Alberte Jacobs, RN, Carolyn Sharp, RN, and Vanessa Walker for help with this project.
Grant Support: By a grant-in-aid from the American Heart Association.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  G. S. Doig and F. Simpson Evidence-Based Nutrition Guidelines for Critically Ill Adults--Reply JAMA, April 15, 2009; 301(15): 1543 - 1544. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Sellier, I. Colombet, B. Sabatier, G. Breton, J. Nies, E. Zapletal, J.-B. Arlet, D. Somme, and P. Durieux Effect of Alerts for Drug Dosage Adjustment in Inpatients with Renal Insufficiency J. Am. Med. Inform. Assoc., March 1, 2009; 16(2): 203 - 210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Guerra, P. A. Gimotty, J. A. Shea, J. A. Pagan, J. S. Schwartz, and K. Armstrong Effect of Guidelines on Primary Care Physician Use of PSA Screening: Results from the Community Tracking Study Physician Survey Med Decis Making, September 1, 2008; 28(5): 681 - 689. [Abstract] [PDF]
|
|
|
|
 |
|
 S. R. Majumdar, B. H. Rowe, D. Folk, J. A. Johnson, B. H. Holroyd, D. W. Morrish, W. P. Maksymowych, I. P. Steiner, C. H. Harley, B. J. Wirzba, et al. A Controlled Trial To Increase Detection and Treatment of Osteoporosis in Older Patients with a Wrist Fracture Ann Intern Med, September 7, 2004; 141(5): 366 - 373. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J. Schunemann, D. Cook, J. Grimshaw, A. Liberati, J. Heffner, V. Tapson, and G. Guyatt Antithrombotic and Thrombolytic Therapy: From Evidence to Application: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 688S - 696S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Johnson, C. T. Kassner, and J. S. Kutner Current use of guidelines, protocols, and care pathways for symptom management in hospice American Journal of Hospice and Palliative Medicine, January 1, 2004; 21(1): 51 - 57. [Abstract] [PDF]
|
|
|
|
 |
|
 K. F. Welke, B. J. Boots Miller, K. D. McCoy, T. E. Vaughn, M. M. Ward, S. D. Flach, P. M. Peloso, B. A. Sorofman, T. Tripp-Reimer, and B. N. Doebbeling What Factors Influence Provider Knowledge of a Congestive Heart Failure Guideline in a National Health Care System? American Journal of Medical Quality, May 1, 2003; 18(3): 122 - 127. [Abstract] [PDF]
|
|
|
|
 |
|
 B. Yueh, E. M. Weaver, E. H. Bradley, H. M. Krumholz, P. Heagerty, A. Conley, and C. T. Sasaki A Critical Evaluation of Critical Pathways in Head and Neck Cancer Arch Otolaryngol Head Neck Surg, January 1, 2003; 129(1): 89 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Erhardt, J. Herlitz, L. Bossaert, M. Halinen, M. Keltai, R. Koster, C. Marcassa, T. Quinn, and H. van Weert Task force on the management of chest pain Eur. Heart J., August 1, 2002; 23(15): 1153 - 1176. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schmidt, P. K. Lindenauer, J. L. Fitzgerald, and E. M. Benjamin Forecasting the Impact of a Clinical Practice Guideline for Perioperative {beta}-Blockers to Reduce Cardiovascular Morbidity and Mortality Arch Intern Med, January 14, 2002; 162(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Medow, T. J. Wilt, S. Dysken, S. D. Hillson, S. Woods, and S. J. Borowsky Effect of Written and Computerized Decision Support Aids for the U.S. Agency for Health Care Policy and Research Depression Guidelines on the Evaluation of Hypothetical Clinical Scenarios Med Decis Making, October 1, 2001; 21(5): 344 - 356. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Graff Three generations of recurrent dislocated shoulders. Emerg. Med. J., March 1, 2001; 18(2): 148 - 149. [Full Text]
|
|
|
|
|
|
S. Weingarten Translating Practice Guidelines Into Patient Care : Guidelines at the Bedside Chest, August 1, 2000; 118(2_suppl): 4S - 7S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Durieux, R. Nizard, P. Ravaud, N. Mounier, and E. Lepage A Clinical Decision Support System for Prevention of Venous Thromboembolism: Effect on Physician Behavior JAMA, June 7, 2000; 283(21): 2816 - 2821. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Lee and L. Goldman Evaluation of the Patient with Acute Chest Pain N. Engl. J. Med., April 20, 2000; 342(16): 1187 - 1195. [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Sills, Z. J. Huang, C. Shao, M. F. Guagliardo, J. M. Chamberlain, and J. G. Joseph Pediatric Milliman and Robertson Length-of-Stay Criteria: Are They Realistic? Pediatrics, April 1, 2000; 105(4): 733 - 737. [Abstract] [Full Text]
|
|
|
|
 |
|
 G. A. Ewy and J. P. Ornato Emergency cardiac care: introduction J. Am. Coll. Cardiol., March 15, 2000; 35(4): 825 - 880. [Full Text] [PDF]
|
|
|
|
|
|
E. A. Iliadis, L. W. Klein, B. J. Vandenberg, D. Spokas, T. Hursey, J. E. Parrillo, and J. E. Calvin Clinical practice guidelines in unstable angina improve clinical outcomes by assuring early intensive medical treatment J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1689 - 1695. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Retchin Variations in Medicare Health Maintenance Organizations JAMA, February 24, 1999; 281(8): 755 - 756. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Chen, D. G. Frame, and T. J. White Efficacy of Ondansetron and Prochlorperazine for the Prevention of Postoperative Nausea and Vomiting After Total Hip Replacement or Total Knee Replacement Procedures: A Randomized, Double-blind, Comparative Trial Arch Intern Med, October 26, 1998; 158(19): 2124 - 2128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Sibbald and J. D. Kossuth The Ontario Health Care Evaluation Network and the Critical Care Research Network as Vehicles for Research Transfer Med Decis Making, January 1, 1998; 18(1): 9 - 16. [Abstract] [PDF]
|
|
|
|
 |
|
 E. L. Feldman, A. Jaffe, N. Galambos, A. Robbins, R. B. Kelly, and J. Froom Clinical Practice Guidelines on Depression: Awareness, Attitudes, and Content Knowledge Among Family Physicians in New York Arch Fam Med, January 1, 1998; 7(1): 58 - 62. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Lee and H. L. Cooper Translating Good Advice Into Better Practice JAMA, December 17, 1997; 278(23): 2108 - 2109. [Abstract] [PDF]
|
|
|
|
|
|
G. Ellrodt, D. J. Cook, J. Lee, M. Cho, D. Hunt, and S. Weingarten Evidence-Based Disease Management JAMA, November 26, 1997; 278(20): 1687 - 1692. [Abstract] [PDF]
|
|
|
|
|
|
L. C. Kleinman, E. A. Boyd, and J. C. Heritage Adherence to Prescribed Explicit Criteria During Utilization Review: An Analysis of Communications Between Attending and Reviewing Physicians JAMA, August 13, 1997; 278(6): 497 - 501. [Abstract] [PDF]
|
|
|
|
|
|
G.-R. Auleley, P. Ravaud, B. Giraudeau, L. Kerboull, R. Nizard, P. Massin, C. G. de Loubresse, C. Vallee, and P. Durieux Implementation of the Ottawa Ankle Rules in France: A Multicenter Randomized Controlled Trial JAMA, June 25, 1997; 277(24): 1935 - 1939. [Abstract] [PDF]
|
|
|
|
|
|
D. S. Harr, E. A. Balas, and J. Mitchell Developing Quality Indicators as Educational Tools to Measure the Implementation of Clinical Practice Guidelines American Journal of Medical Quality, December 1, 1996; 11(4): 179 - 185. [PDF]
|
|
|
|
|
|
L. Goldman, E. F. Cook, P. A. Johnson, D. A. Brand, G. W. Rouan, and T. H. Lee Prediction of the Need for Intensive Care in Patients Who Come to Emergency Departments with Acute Chest Pain N. Engl. J. Med., June 6, 1996; 334(23): 1498 - 1504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch Trends in Diagnostic Testing Following a National Guideline for Evaluation of Dyspepsia Arch Intern Med, April 22, 1996; 156(8): 873 - 875. [Abstract] [PDF]
|
|
|
|
|
|
S. D. Pearson, D. Goulart-Fisher, and T. H. Lee Critical Pathways as a Strategy for Improving Care: Problems and Potential Ann Intern Med, December 15, 1995; 123(12): 941 - 948. [Abstract] [Full Text]
|
|
|
|
|
|
M. C. Wilson, R. S. A. Hayward, S. R. Tunis, E. B. Bass, G. Guyatt, Evidence-Based Medicine Working Group, D. Cook, B. Haynes, R. Jaeschke, A. Laupacis, et al. Users' Guides to the Medical Literature: VIII. How to Use Clinical Practice Guidelines B. What Are the Recommendations and Will They Help You in Caring for Your Patients? JAMA, November 22, 1995; 274(20): 1630 - 1632. [Abstract] [PDF]
|
|
|
|
|
|
P. A. Ubel and R. M. Arnold The Unbearable Rightness of Bedside Rationing: Physician Duties in a Climate of Cost Containment Arch Intern Med, September 25, 1995; 155(17): 1837 - 1842. [Abstract] [PDF]
|
|
|
|
|
|
R. S. A. Hayward, M. C. Wilson, S. R. Tunis, E. B. Bass, G. Guyatt, and Evidence-Based Medicine Working Group Users' Guides to the Medical Literature: VIII. How to Use Clinical Practice Guidelines A. Are the Recommendations Valid? JAMA, August 16, 1995; 274(7): 570 - 574. [Abstract] [PDF]
|
|
|
|
|
|
L. A. Headrick and D. Neuhauser Quality Health Care JAMA, June 7, 1995; 273(21): 1718 - 1720. [Abstract] [PDF]
|
|
|
|
|
|
C. S. Landefeld, R. M. Palmer, D. M. Kresevic, R. H. Fortinsky, and J. Kowal A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients N. Engl. J. Med., May 18, 1995; 332(20): 1338 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. V. Pauly Practice Guidelines: Can They Save Money? Should They? J. Law Med. Ethics, March 1, 1995; 23(1): 65 - 74. [PDF]
|
|
