Three years of a clinical practice guideline for uncomplicated pelvic inflammatory disease in adolescents

Purpose: To study the effect of continued use of a clinical practice guidel ine (CPG) on the course of admissions for uncomplicated pelvic inflammatory disease (PID) over 3 consecutive fiscal years (FY). Methods: Medical charts, computerized laboratory records, and hospital char ge data were reviewed for 165 consecutive inpatient admissions of adolescen ts meeting clinical criteria for PID during PY 1994, 1995, and 1996. Data w ere analyzed to compare demographics, clinical variables, length of stay (L OS), and hospital charges (total, nursing, and pharmacy) across the three F Ys. Results: Of admissions for clinical PID, 65% had a discharge diagnosis of P ID. Of those, 90% were uncomplicated PID. Among admissions with a discharge diagnosis of uncomplicated PID, reductions were seen in mean LOS (3.75 day s in FY 1994 vs. 3.24 days in FY 1995 vs. 3.08 days in FY 1996; p = .047), proportion of admissions lasting longer than 3 days (48% vs. 24% vs. 20%; p less than or equal to .022), and mean pharmacy charge ($946 vs. $806 vs. $ 731; p = .002). For all admissions to CPG, mean LOS, proportion of prolonge d admissions, and mean total and pharmacy charges also decreased over the f irst 2 years but increased in FY 1996. More patients in FY 1996 met the thr ee major clinical criteria plus at least one additional criterion (76% in F Y 1996 vs. 26% in FY 1994 and 53% in FY 1995; p < .0005) and had pelvic ult rasounds (80% in FY 1996 vs. 56% in FY 1994 and 45% in FY 1995; p less than or equal to .001) than in other FYs. Conclusions: Continued use of a CPG can reduce hospital LOS, charges, and p rolonged admissions of adolescents with uncomplicated PID. Over 3 years, va riations in clinical practice such as admitting sicker patients may attenua te the effect of the CPG. (C) Society for Adolescent Medicine, 2000.