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Related Experiment Videos

Can practice guidelines be transported effectively to different settings? Results from a multicenter interventional

J H Lichtman1, S A Roumanis, M J Radford

  • 1Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, Department of Neurology, Yale University School of Medicine, New Haven, USA.

The Joint Commission Journal on Quality Improvement
|January 9, 2001
PubMed
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Implementing clinical guidelines for chest pain across different hospitals showed varied adherence and no impact on patient outcomes. Local factors significantly influence guideline success, highlighting the need for tailored approaches.

Area of Science:

  • Healthcare Management
  • Clinical Practice Guidelines
  • Translational Research

Background:

  • Clinical guidelines aim to standardize care and improve outcomes.
  • Effectiveness and implementation factors of guidelines in new settings are poorly understood.
  • This study evaluated a low-risk chest pain guideline in five diverse hospital settings.

Purpose of the Study:

  • To assess the transportability and effectiveness of a standardized low-risk chest pain clinical guideline across multiple hospital settings.
  • To identify factors influencing the successful translation of clinical guidelines into practice.

Main Methods:

  • Prospective interventional trial involving 553 low-risk chest pain patients.
  • Standardized protocol implementation over a 6-month intervention period.

Related Experiment Videos

  • Measurement of guideline adherence (discharge within 48 hours), clinical outcomes, patient satisfaction, and interviews with local champions.

    • Main Results:

    • Guideline adherence varied significantly (61%-100%) across sites, with limited improvement from baseline.
    • No significant impact on clinical outcomes or patient satisfaction was observed.
    • Hospital environment, team staffing, and barrier resolution influenced implementation success.

    Conclusions:

    • Standardized implementation protocols did not guarantee consistent results across institutions for chest pain guidelines.
    • Successful guideline translation requires understanding and addressing local institutional factors.
    • Tailoring implementation strategies to specific hospital contexts is crucial.