A time series of 110 patients with acute myocardial infarction admitted between January 1992 and June 1997 examined the effects of a clinical pathway. The pathway reduced length of hospital stay by 2.2 days and hospital charges by $1,008 without compro mising care quality and outcomes.
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References
1.
Gunnar RM, Bowdillon Pdv, Dixon DW, et al: Guidelines for the early management of patients with acute myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (subcommittee to develop guidelines for the early management of patients with acute myocardial infarction). J Am Coll Cardiol16:249-252, 1990.
2.
Meehan TP, Hennen J., Radford MJ, et al: Process and outcome of care for acute myocardial infarction among Medicare beneficiaries in Connecticut. A quality improvement demonstration project. Ann Intern Med122:928-936, 1995.
3.
Brand DA, Newcomer LN, Freiburger A., et al: Cardiologists practices compared with practice guidelines. Use of beta-blockade after acute myocardial infarction. J Am Coll Cardiol26:1432-1436, 1995.
4.
Marciniak TA , Ellerbeck EF, Radford MJ, et al: Improving the quality of care for Medicare patients with acute myocardial infarction. Results from the cooperative cardiovascular project. JAMA279:1351-1357, 1998.
5.
O'Connor GT, Quinton HB, Traven ND, et al: Geographic variation in the treatment of acute myocardial infarction . The Cooperative Cardiovascular Project. JAMA281:627-633, 1999.
6.
Pearson SD, Goulart-Fisher D., Lee TH: Critical pathways as a strategy for improving care: Problems and potential . Ann Intern Med123:941-948, 1995.
7.
Kegel LM: Case management, critical pathways, and myocardial infarction. Crit Care Nurse16:97-112, 1996.
8.
Nichol G., Walls R., Goldman L., et al: A critical pathway for management of patients with acute chest pain who are at low risk for myocardial ischemia: Recommendations and potential impact. Ann Intern Med127:996-1005, 1997.
9.
Zalenski RJ, McCarren M., Roberts R., et al: An evaluation of a chest pain diagnostic protocol to exclude acute cardiac ischemia in the Emergency Department. Arch Intern Med157:1085-1091, 1997.
10.
Cannon CP, Antman EM, Walls R., et al: Time as an adjunctive agent to thrombolytic therapy. J Thromb Thrombolysis1:27-34, 1994.
11.
Kulick DL, Rahimtoola SH: Risk stratification in survivors of acute myocardial infarction: Routine cardiac catheterization and angiography is a reasonable approach in most patients . Am Heart J121:641-656, 1991.
12.
The TIMI IIIB Investigators: Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q wave myocardial infarction: Results of the TIMI IIIB trial. Circulation89:1545-1556, 1994.
13.
Ryan TJ, Anderson JL, Antman EM, et al: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol28:1328-1342, 1996.
14.
Boden WE, O'Rourke RA, Crawford MH, et al: Outcomes in patients with acute non-Q wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy.Veterans Affairs Non-Q Wave Infarctions Strategies in Hospital (VANQWISH) Trial Investigators .N Engl J Med338:1785-1792, 1998.
15.
Ellrodt AG, Conner L., Riedinger M., et al: Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial. Ann Intern Med122:277-282, 1995.
16.
Newby LK, Califf RM, Guerci A., et al: Early discharge in the thrombolytic era: An analysis of criteria for uncomplicated infarction from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) trial. J Am Coll Cardiol27:625-632, 1996.
17.
Reeder GS, Bailey KR, Gersh BJ, et al, for the Mayo Coronary Care Unit and Catheterization Laboratory Groups: Cost comparison of immediate angioplasty versus thrombolysis followed by conservative therapy for acute myocardial infarction: A randomized prospective trial. Mayo Clin Proc69:5-12, 1994.
18.
Barbagelata A., Granger CB, Topol EJ, et al, for the TAMI Study Group: Frequency, significance, and cost of recurrent ischemia after thrombolytic therapy for acute myocardial infarction. Am J Cardiol76:1007-1013, 1995.
19.
Jollis JG, DeLong ER, Peterson ED, et al: Outcome of acute myocardial infarction according to the specialty of the admitting physician. N Engl J Med335:1880-1887, 1996.
20.
Sanz G., Betriu A., Oller G., et al: Feasibility of early discharge after acute Q wave myocardial infarction in patients not receiving thrombolytic treatment. J Am Coll Cardiol22:1795-1801, 1993 .
21.
Wilkinson P. , Stevenson R., Ranjadayalan K., et al: Early discharge after acute myocardial infarction: Risks and benefits. Br Heart J74:71-75, 1995.
22.
Grines CL, Marsalese DL, Brodie B., et al: Safety and cost-effectiveness of early discharge after primary angioplasty in low-risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction. J Am Coll Cardiol31:967-972, 1998.