0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Practice Guidelines and Reminders to Reduce Duration of Hospital Stay for Patients with Chest Pain: An Interventional Trial

Scott R. Weingarten, MD, MPH; Mary S. Riedinger, RN, MSN; Laura Conner, RN; Thomas H. Lee, MD, MSc; Irwin Hoffman, MD; Betty Johnson, RN; and A. Gray Ellrodt, MD
[+] Article and Author Information

From the Cedars-Sinai Medical Center, Los Angeles, California; Brigham and Women's Hospital, Boston, Massachusetts. Requests for Reprints: Scott Weingarten, MD, Cedars-Sinai Medical Center, Department of Medicine, Becker 146, 8700 Beverly Boulevard, Los Angeles, CA 90048. Grant Support: By a grant-in-aid from the American Heart Association. 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.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(4):257-263. doi:10.7326/0003-4819-120-4-199402150-00001
Text Size: A A A

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.

Figures

Grahic Jump Location
Figure 1.
Patients' length of stay analyzed with time.
Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)