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

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Název: Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.
Autoři: Wasserfallen, J.B., Berger, A., Eckert, P., Stauffer, J.C., Schlaepfer, J., Gillis, D., Cornuz, J., Schaller, M.D., Kappenberger, L., Yersin, B.
Rok vydání: 2025
Sbírka: Université de Lausanne (UNIL): Serval - Serveur académique lausannois
Témata: 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, Health Care/statistics & numerical data, Switzerland
Popis: 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.
Druh dokumentu: article in journal/newspaper
Popis souboru: application/pdf
Jazyk: English
ISSN: 1353-4505
15375099
Relation: International Journal for Quality in Health Care; https://iris.unil.ch/handle/iris/196827; serval:BIB_B3C9D89F9353; 000224301000008
DOI: 10.1093/intqhc/mzh069
Dostupnost: https://iris.unil.ch/handle/iris/196827
https://doi.org/10.1093/intqhc/mzh069
Přístupové číslo: edsbas.891C7D64
Databáze: BASE
Popis
Abstrakt: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.
ISSN:13534505
15375099
DOI:10.1093/intqhc/mzh069