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.