PRACTICE GUIDELINES AND REMINDERS TO REDUCE DURATION OF HOSPITAL STAYFOR PATIENTS WITH CHEST PAIN - AN INTERVENTIONAL TRIAL

Objective: The acceptability, safety, and efficacy of practice guideli nes have rarely been evaluated. Moreover, despite the recent developme nt of guidelines and decision aids for patients admitted to coronary c are and intermediate care units, few have been tested in clinical prac tice. Design: A prospective, controlled clinical trial with an alterna te-month design, Setting. A large teaching community hospital. Patient s: Patients admitted to coronary care and intermediate care units with chest pain who were considered at low risk for complications accordin g to a practice guideline (n = 375). Intervention: Physicians caring f or patients with chest pain who were at low risk for complications rec eived concurrent, personalized written and verbal reminders regarding a guideline that recommended a 2-day hospital stay. Results: Use of th e practice guideline recommendation with concurrent reminders was asso ciated 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 day s (0.91-day reduction, 95% Cl, 0.18 to 1.63; P = 0.02) for all patient s with chest pain considered at low risk for complications. The interv ention was associated with a total (direct and indirect) cost reductio n of $1397 per patient (Cl, $176 to $2618; P = 0.03). No significant d ifference 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 d ischarge. Conclusion: These results suggest that implementation of thi s practice guideline through concurrent reminders reduced hospital cos ts for patients with chest pain considered at low risk for complicatio ns. Further studY of the guideline is warranted.