title: Cost-effective medicine: the financial impact that practice guidelines have on outpatient hospital charges in the emergency department.
abstract: The objective of this study was to determine whether specific cost-effective guidelines based on a patient's chief complaint can significantly reduce outpatient hospital charges in the ED. A prospective randomized single-blinded clinical trial was conducted in an urban community hospital ED with a 14,000 annual census. The first phase of the study involved preintervention data collection. The second phase focused on development, physician approval, and implementation of 23 specific cost-effective guidelines, as well as general recommendations for diagnostic tests. The third phase involved postintervention data collection. Results showed that the total outpatient hospital charge decreased by 28% per patient. The laboratory hospital charge decreased by 46% per patient. The radiology hospital charge decreased by 20% per patient. The hospital supply charge and pharmacy charge decreased by 31% per patient and 11% per patient, respectively. In conclusion, cost-effective medicine practiced with specific guidelines, based on a patient's chief complaint, significantly reduces unnecessary diagnostic tests and medical treatments ordered by emergency physicians.
authors.affiliation: Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, 60612, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Guterman
authors.forename: M J
authors.initials: MJ
authors.lastname: VanRooyan
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D000720:Ancillary Services, Hospital / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000191:economics; D017722:Hospital Charges; D006764:Hospitals, Community / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014481:United States