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Effects of Practice Guidelines and Feedback

Kim A. Eagle, MD; Albert G. Mulley, MD; Steven J. Skates, PhD; Victoria A. Reder, MPH; Britain W. Nicholson, MD; Jayne O. Sexton, RN; G. Octo Barnett, MD; George E. Thibault, MD

JAMA. 1990;264(8):992-997.

Abstract
We developed consensus management guidelines for patients admitted with chest pain, pulmonary edema, and syncope and used these guidelines to examine practice variation and the effects of physician feedback on decision making in 1145 consecutive admissions to three medical intensive care units. Data collection included a 6-month baseline period and two 6-month physician feedback periods. Hospital length of stay fell from 8.34 days to 7.41 and 7.14 days during feedback; intensive care unit length of stay fell from 2.45 days to 2.23 and 2.07 days. Feedback was associated with an increase in the percentage of patients conforming to the management guidelines. Multiple linear regression showed that feedback correlated with reductions of 0.79 days (confidence interval, 0.12 to 1.46) in hospital length of stay and 0.21 days (confidence interval 0.05 to 0.37) in intensive care unit length of stay. This effect was most apparent in patients not requiring any intervention, but with a major complication. During the 6-month follow-up, mortality, readmission, and urgent readmission rates were similar for patients admitted in baseline and feedback periods.

(JAMA. 1990;264:992-997)

Author Affiliations
From the Medical Services, Massachusetts General Hospital, Boston (Drs Eagle, Mulley, Skates, Nicholson, and Barnett and Mss Reder and Sexton); and the Veterans Administration Medical Center, West Roxbury, Mass (Dr Thibault).

Footnotes
Reprint requests to Cardiac and General Medicine Units. Massachusetts General Hospital, Bulfinch 1, Boston, MA 02114 (Dr Eagle).

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