Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.

Details

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Serval ID
serval:BIB_B3C9D89F9353
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.
Journal
International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua
Author(s)
Wasserfallen J.B., Berger A., Eckert P., Stauffer J.C., Schlaepfer J., Gillis D., Cornuz J., Schaller M.D., Kappenberger L., Yersin B.
ISSN
1353-4505 (Print)
ISSN-L
1353-4505
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
16
Number
5
Pages
383-389
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article
Publication Status: ppublish
Abstract
OBJECTIVE: To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment.
DESIGN: Prospective before-after evaluation over a 3-month period.
SETTING: The emergency ward of a tertiary teaching hospital.
PATIENTS: All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods.
INTERVENTION: Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team.
MAIN OUTCOME MEASURES: Diagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation.
RESULTS: The clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment.
CONCLUSION: Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.
Keywords
Acute Disease, Clinical Competence/statistics & numerical data, Electrocardiography, Emergency Medicine/standards, Emergency Service, Hospital/standards, Female, Guideline Adherence/statistics & numerical data, Hospitals, Teaching, Humans, Male, Middle Aged, Myocardial Infarction/diagnosis, Practice Guidelines as Topic, Prospective Studies, Quality Assurance, Health Care/methods, Quality Assurance, Health Care/statistics & numerical data, Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
14/03/2008 10:20
Last modification date
25/09/2019 6:10
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