title: Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.
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.
  
  
  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.
authors.affiliation: Internal Medicine, University Hospital (CHUV), CH-01011 Lausanne, VD, Switzerland. jwasserf@chuv.hospvd.ch
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
authors.forename: Alexandre
authors.initials: A
authors.lastname: Berger
authors.forename: Philippe
authors.initials: P
authors.lastname: Eckert
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Stauffer
authors.forename: Jürg
authors.initials: J
authors.lastname: Schlaepfer
authors.forename: Dominique
authors.initials: D
authors.lastname: Gillis
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.forename: Marie-Denise
authors.initials: MD
authors.lastname: Schaller
authors.forename: Lukas
authors.initials: L
authors.lastname: Kappenberger
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
mesh_terms: 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