THE EFFECTS OF AN OUTPATIENT PRACTICE GUIDELINE AT A TEACHING HOSPITAL - A PROSPECTIVE PILOT-STUDY

Practice guidelines (PGs) are becoming increasingly important in moder n medicine. To study the effects of a PG, we performed a pilot study a t a large, urban, public teaching hospital according to a prospective, observational research design with both concurrent and historic contr ols. Specifically, we studied the effects of a multidisciplinary PG fo r pediatric outpatient tonsillectomy and adenoidectomy on the process of health-care delivery. Variables in the health-care process included patient compliance with clinic and surgery appointments, surgery time , operating room turnover, time in recovery room, unplanned admission rate, patient compliance with postoperative follow-up, provider compli ance with guidelines, and hospital charges. Patients in the PG were fo und to have fewer preoperative laboratory tests, decreased duplication of services, and shorter operating room turnover times. Provider comp liance with the PG varied by service and was intermittent at first but improved gradually. There was a trend toward improved compliance with postoperative follow-up in patients in the PG. Provider opinions conc erning the guideline were positive. This pilot study demonstrates seve ral advantages and disadvantages of the use of PGs in the outpatient s etting and in a teaching hospital.