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Ann Intern Med. 1995 Mar 15;122(6):434-7.

Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain.

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  • 1Brigham and Women's Hospital, Boston, MA.

Abstract

OBJECTIVE:

To test whether a low-intensity, nonintrusive intervention improved the efficiency of management of patients with acute chest pain.

DESIGN:

Time-series trial with six 14-week cycles, each including a 5-week intervention period and a 5-week control period separated by 2-week "washout" periods.

SETTING:

Urban teaching hospital.

PATIENTS:

1921 patients aged 30 years or older with acute chest pain unexplained by local trauma or chest radiograph.

INTERVENTION:

Risk estimates and triage recommendations were made available to physicians at the time of emergency department evaluation and, for hospitalized patients, on a daily basis before morning rounds. Flowsheets and stickers, but no direct human contact, were used to transmit this information.

MEASUREMENTS:

Rates of admission to the hospital and coronary care unit, inpatient costs, and lengths of stay.

RESULTS:

Rates of admission during intervention and control periods were similar in both the hospital (52% and 51%, respectively) and the coronary care unit (10% and 10%, respectively). Total lengths of stay in the hospital were similar (4.9 +/- 5.9 days and 4.9 +/- 5.7 days, respectively), as were average total costs ($7822 +/- $13,217 and $7955 +/- $13,400, respectively). No differences in management were detected for the subgroup of patients with low clinical risk for acute myocardial infarction.

CONCLUSIONS:

The use of information alone--without direct human contact--did not affect management of patients with acute chest pain at this hospital. Although this low-intensity intervention might be more effective for other conditions and in other settings, our data support the use of other strategies to affect physician decision making.

PMID:
7856992
[PubMed - indexed for MEDLINE]
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