Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Siebens, Kaat; Miljoen, Hielko; Fieuws, Steffen; Drew, Barbara J.; Geest, Sabina De; Vrints, Christiaan

doi:10.1097/hpc.0b013e3181d24549

Cited by 16 publications

(17 citation statements)

References 27 publications

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“…This result was in consistent with a previous study's findings which demonstrated that anxiety and uncertainty were significantly reduced after participants completed an online education intervention, after undergoing cervical disc herniation surgery [11]. Another study examining patients with chest pain demonstrated that a clinical schedule positively influenced patient's length of stay and satisfaction; however, patient's anxiety was not significantly reduced post-intervention [34]. Another study addressing adult cancer patients showed that the clinical schedule could support cancer caring to assess and manage patient's anxiety and depression [35].…”

Section: Discussionsupporting

confidence: 91%

Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease

Lim¹,

Kim²

2019

TONURSJ

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Background:Many patients facing spinal surgery experience fear and anxiety about surgery, anesthesia, risk of postoperative pain or complications, or even death. Spinal surgery patients often experience mobility disorders due to lasting postoperative pain and require aids such as spinal braces, which can induce depression. Alleviating patients’ anxiety and depression during the perioperative period by utilizing consistent and standardized information is required for high-quality care.Objective:We developed and assessed a standardized care protocol for degenerative spinal surgery patients.Methods:The protocol was developed through focus group interviews with spinal surgery patients and the recommendations of an expert panel. Then, a quasi-experimental design was employed to comparatively study patients undergoing spinal surgery. Ninety-eight Patients were assigned to either a treatment group (n= 49) or a control group (n= 49). The treatment group received an intervention based on the newly developed standardized care protocol, while the control group received traditional care. After treatment, participants’ anxiety, depression, uncertainty, and care satisfaction were compared between groups.Results:Patients who had received the care protocol-based intervention showed lower anxiety, depression, and uncertainty, and higher satisfaction than did those who received traditional care.Conclusion:The developed care protocol may be useful for reducing anxiety and depression and for improving the healthcare provided to spinal surgery patients, as it involves the proactive dissemination of accurate information throughout the hospitalization process. The protocol also positively affected patients’ uncertainty and satisfaction with their medical care.

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Section: Discussionsupporting

confidence: 91%

Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease

Lim¹,

Kim²

2019

TONURSJ

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“…Other authors have reported that guideline-based standardized care in patients with acute myocardial infarction is associated with considerably lower mortality, shorter hospital length of stay, and lower healthcare cost [5,6]. Early reperfusion strategies including the initiation of fibrinolysis and/or transfer to an appropriate PCI-capable or non-PCI-capable center are among the most important factors.…”

Section: Discussionmentioning

confidence: 99%

Effects of a standard operating procedure on prehospital emergency care of patients presenting with symptoms of the acute coronary syndrome

Francis

Bubser

Schmidbauer

et al. 2014

European Journal of Emergency Medicine

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To determine whether a standard operating procedure (SOP) for prehospital management of patients with the acute coronary syndrome (ACS) improves the quality of patient care in terms of adherence to treatment guidelines of the European Society of Cardiology. Among a total of 1025 patient medical records collected from a period before and after the introduction of the SOP, 269 records included the working diagnosis of ACS and were then reviewed for guideline adherence. Most aspects of patient evaluation, monitoring, treatment, and hospital allocation were fairly guideline adherent (>70%) before the SOP was introduced and were not affected by the SOP. The percentage of cases in whom sublingual nitrate (55.2 vs. 66.7%) or intravenous morphine (26.9 vs. 43.0%) was administered without contraindications was higher after the SOP had been introduced. Therefore, the use of an SOP in prehospital emergency medicine can partly improve the adherence to guideline recommendations for the treatment of patients with ACS.

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“…Previous studies have reported the impact of clinical observation or clinical diagnosis units, particularly chest-pain units. [5][6][7][8][9][10][11][12][13][14][15] Studies of hospitalist-run units suggest shorter LOS in the entire hospital, 16 or in the target unit. 17 Although one study suggested a lower 30-day readmission rate, 18 most others did not describe this effect.…”

Section: Discussionmentioning

confidence: 99%

Caring for patients in a hospitalist‐run clinical decision unit is associated with decreased length of stay without increasing revisit rates

Aplin

McAllister

Kupersmith

et al. 2014

Journal of Hospital Medicine

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BACKGROUND Observation medicine is a growing field with increasing involvement by hospitalists. Little has been written regarding clinical outcomes in hospitalist‐run clinical decision units (CDUs). OBJECTIVE To determine the impact of a hospitalist‐run geographic CDU on length of stay (LOS) for observation patients. Secondary objectives included examining the impact on 30‐day emergency department (ED) or hospital revisit rates. DESIGN Retrospective cohort study with pre‐ and post‐implementation analysis. SETTING Urban, academic, 600‐bed teaching hospital in Camden, New Jersey. PATIENTS Observation patients discharged from medical–surgical units before and after CDU opening and those discharged from the CDU after CDU opening. INTERVENTION Creation of a hospitalist‐run, 20‐bed geographic CDU, adjacent to the ED with order sets, protocols, and priority consults and testing. MEASUREMENTS Median LOS for observation patients was calculated for 7 months pre‐ and post‐CDU implementation. ED and hospital revisits requiring an observation or inpatient stay within 30 days of discharge were measured. RESULTS CDU observation patients had a lower median LOS than medical–surgical observation patients during the same period (17.6 hours vs 26.1 hours, P < 0.001). CDU LOS was lower than medical–surgical observation LOS in the 7 months 1 year prior to CDU implementation (17.6 hours vs 27.1 hours, P < 0.001). CDU patients had a similar 30‐day ED or hospital revisit rate compared with observation patients pre‐CDU. CONCLUSIONS Implementing a hospitalist‐run geographic CDU was associated with a 35% decrease in observation LOS for CDU patients compared with a 3.7% decrease for medical–surgical observation patients. CDU LOS decreased without increasing ED or hospital revisit rates. Journal of Hospital Medicine 2014;9:391–395. © 2014 Society of Hospital Medicine

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Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Abstract: A critical pathway can effectively and safely reduce LOS, increase patient satisfaction, and improve adherence to the guidelines for managing patients with chest pain. Anxiety is not statistically significantly reduced by this intervention.

Cited by 16 publications

References 27 publications

Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease

Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease

Effects of a standard operating procedure on prehospital emergency care of patients presenting with symptoms of the acute coronary syndrome

Caring for patients in a hospitalist‐run clinical decision unit is associated with decreased length of stay without increasing revisit rates

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