REDUCING LENGTHS OF STAY FOR PATIENTS HOSPITALIZED WITH CHEST PAIN USING MEDICAL-PRACTICE GUIDELINES AND OPINION LEADERS
REDUCING LENGTHS OF STAY FOR PATIENTS HOSPITALIZED WITH CHEST PAIN USING MEDICAL-PRACTICE GUIDELINES AND OPINION LEADERS
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DOI：
10.1016/0002-9149(93)90787-d
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发表时间：
1993-02-01
影响因子：
2.8
通讯作者：
ELLRODT, AG
中科院分区：
文献类型：
--
作者：
WEINGARTEN, S;AGOCS, L;ELLRODT, AG
关于医疗实践指南在冠心病监护病房和中级监护病房用于患者护理时的有效性和安全性，现有的数据很少。本研究的目的是检验对医生进行实践指南教育对促进因胸痛住院的“低风险”患者缩短住院时间的效果。这些指南通过教育会议、书面备忘录、意见领袖的认可、同时的书面反馈以及护士对医生的提示等方式，传达给了在一个健康维护组织（HMO）工作的医生。共有208名患者参与了这项研究。在实践指南实施后，低风险胸痛患者的住院时间从2.51±2.1天减少到1.96±1.3天（减少了22%，p = 0.03），中级监护病房的住院时间从33.9±19小时减少到28.2±14小时（减少了17%，p = 0.02）。低风险胸痛患者住院时间的减少超过了因未引入指南的心脏疾病住院患者住院时间的减少。按照指南建议治疗的患者在出院后的2周内没有出现意外的“危及生命”的不良事件（95%，置信区间0%，3%）。这项研究支持了实践指南在减少低风险胸痛患者住院时间方面的有效性和可能的安全性。
There are few available data on the effectiveness and safety of medical practice guidelines when used for patient care in the coronary and intermediate care units. The aim of this study was to examine the effect of educating physicians about practice guidelines to promote shorter lengths of stay for ''low-risk'' patients hospitalized with chest pain. Such guidelines were disseminated to physicians working in a health maintenance organization (HMO) by educational conferences, written memoranda, endorsement by opinion leaders, concurrent written feedback, and nursing-to-physician cues. A total of 208 patients were enrolled in the study. Following implementation of the practice guidelines, hospital lengths of stay were reduced from 2.51 +/- 2.1 to 1.96 +/- 1.3 days (22% reduction, p = 0.03) and intermediate care unit lengths of stay from 33.9 +/- 19 to 28.2 +/- 14 hours (17% reduction, p = 0.02) for patients with low-risk chest pain. The reduction in length of stay for patients with low-risk chest pain exceeded reductions in stay for patients hospitalized with cardiac conditions for which no guidelines were introduced. None of the patients treated according to guideline recommendations had unexpected ''life-threatening'' adverse events in the 2-week period after hospital discharge (95%, confidence interval 0%, 3%).This study supports the effectiveness and possible safety of practice guidelines to reduce lengths of stay for patients with low-risk chest pain.