Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.
OBJECTIVE
To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment.


METHODS
Prospective before-after evaluation over a 3-month period.


METHODS
The emergency ward of a tertiary teaching hospital.


METHODS
All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods.


METHODS
Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team.


METHODS
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.


CONCLUSIONS
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.
Wasserfallen
Jean-Blaise
JB
Internal Medicine, University Hospital (CHUV), CH-01011 Lausanne, VD, Switzerland. jwasserf@chuv.hospvd.ch
Berger
Alexandre
A
Eckert
Philippe
P
Stauffer
Jean-Christophe
JC
Schlaepfer
Jürg
J
Gillis
Dominique
D
Cornuz
Jacques
J
Schaller
Marie-Denise
MD
Kappenberger
Lukas
L
Yersin
Bertrand
B
D000208:Acute Disease; D002983:Clinical Competence / Q000706:statistics & numerical data; D004562:Electrocardiography; D004635:Emergency Medicine / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D013557:Switzerland