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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
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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
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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.


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




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