Early "step down" transfer of low risk patients with chest pain

Article Abstract:

Each year more than $3 billion is spent on patients who are admitted to a coronary care unit (CCU) with chest pain but who have not suffered from a heart attack. This has prompted the drafting of decision aids (triage rules) which are designed to reduce unnecessary admissions to the CCU and thereby reduce costs while not sacrificing adequate patient care. Using these rules, low-risk patients in the CCU and intermediate care unit can be transferred to hospital beds not equipped with cardiac monitoring equipment. This study included 404 low-risk patients with chest pain for whom a heart attack had been ruled out. The researchers evaluated whether triage rules (used by physicians in alternate months) enhanced the utilization of hospital beds in the CCU and intermediate care unit. The use of triage rules reduced the length of stay in the intermediate care unit by 36 percent and the stay in the CCU by 53 percent. Available beds in the intermediate care unit increased by 744 and in the CCU by 372 bed-days each year. The hospital's profits increased by $390,000 per year and their charges decreased by $2.6 million per year. The use of triage rules did not affect the quality of care, and no differences in complication rates were observed between patients transferred to unmonitored beds and those not transferred. These results suggest that the use of triage rules is a safe and cost-effective way of improving hospital bed utilization in the intermediate and coronary care units. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Economic aspects, Cardiac patients, Chest pain, Coronary care units, Triage (Medicine), Progressive patient care

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Measuring and improving physician compliance with clinical practice guidelines: a controlled interventional trial

Article Abstract:

Physicians may not comply with clinical practice guidelines due to patient misclassification, inefficiencies in the health system, and the severity of patient illness. Researchers studied the medical data of 79 low-risk patients with chest pain who were not discharged within three days according to a practice guideline. Thirty-three patients were misclassified according to their risk of complications. Of the 46 who were correctly classified as low-risk patients, 11 were not discharged according to the guidelines because of inefficiencies in the health care system. Seven patients were not discharged within three days because their status worsened. There were no apparent reasons for the delayed discharges of 15 patients, although they tended to be sicker than other low-risk patients who were discharged according to the guidelines. Thirteen patients were not discharged per guideline recommendations because their physicians refused to comply.

Measurement, Practice, Physicians, Medical professions, Medical protocols, Compliance, Compliance (Psychology)

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The relation between systematic reviews and practice guidelines

Article Abstract:

Practice guidelines should be developed after a systematic review of the medical literature on a topic to ensure that the guidelines are based on evidence. These guidelines have been developed to standardize medical treatments and to promote treatments that have been proven to be effective. However, reviewing all the literature on a topic may be a daunting prospect. Consequently, many physicians publish systematic reviews of a topic, which contain all of the valid studies done and a summary of the outcomes.

Methods, Medical research, Practice guidelines (Medicine)

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