Effect of Implementation of Standard Clinical Practice Guideline on Management of Gastrointestinal Bleeding Patients in Emergency Department; a Cross-Sectional Study
Introduction: A clinical practice guideline (CPG) is developed with the aim of improving the quality of health care and reducing unnecessary interventions, hospitalization time, and related costs. Objective: This study attempted to design a standard protocol for gastrointestinal bleeding (GIB) patients. Method: This was a cross-sectional study conducted during 2013 and 2014 in an educational medical center in Isfahan, Iran. A checklist containing questions about waiting time for the services, hospitalization time, and costs was completed for the GIB patients. After this primary data gathering, a CPG was designed, codified, underwent several revisions, and finally implemented. Thereafter, the checklist was completed by GIB patients and compared with the previous ones. Result: Fifty patients in each of the two phases were included. The mean age and sex of the studied patients were not different. The time from emergency departments (ED) arrival until the first visit (14 ± 9.8 Vs. 19.4 ± 13.4 minutes; p = 0.03), hospitalization (73.7 ± 49.2 Vs. 116.2 ± 7.2 hours; p=0.003) and costs (1.3 ± 0.81 Vs. 3.68 ± 3.51 million rials; p < 0.001) were significantly reduced following the CPG implementation. The time from admission until conducting endoscopy was not different in the two study periods (16.5 ± 7.8 Vs. 23.9 ± 24.5 hours, p = 0.89). Conclusion: The implementation of the CPG for the management of GIB patients in the ED resulted in a reduction in the waiting time for the services and, further, reduction of hospitalization time and related costs.
2. Baratloo A, Maleki M. Iranian emergency department overcrowding. J Emerg Practice Trauma. 2015;1(2):39.
3. Esmaeili R, AGHILI SM, Sedaghat M, Afzalimoghaddam M. Causes of Prolonged Emergency Department Stay; a Cross-sectional Action Research. Adv J Emerg Med. 2018;2(2):e18.
4. Kredo T, Bernhardsson S, Machingaidze S, Young T, Louw Q, Ochodo E, et al. Guide to clinical practice guidelines: the current state of play. Int J Qual Health Care. 2016;28(1):122-8.
5. Agrawal P, Kosowsky JM. Clinical practice guidelines in the emergency department. Emerg Med Clin North Am. 2009;27(4):555-67, vii.
6. Turner T, Misso M, Harris C, Green S. Development of evidence-based clinical practice guidelines (CPGs): comparing approaches. Implement Sci. 2008;3:45.
7. Hollon SD, Arean PA, Craske MG, Crawford KA, Kivlahan DR, Magnavita JJ, et al. Development of clinical practice guidelines. Annu Rev Clin Psychol. 2014;10:213-41.
8. Palda VA, Davis D, Goldman J. A guide to the Canadian Medical Association Handbook on Clinical Practice Guidelines. CMAJ. 2007;177(10):1221-6.
9. Heydari F, Maghami MH, Esmailian M, Zamani M. The Effect of Implementation of the Standard Clinical Practice Guideline (CPG) for Management of Multiple Trauma Patients Admitted to an Emergency Department. Adv J Emerg Med. 2018;2(1):e5.
10. Farnoosh L, Hossein-Nejad H, Beigmohammadi MT, Seyedhosseini-Davarani S. Preparation and Implementation of Intrahospital Transfer Protocol for Emergency Department Patients to Decrease Unexpected Events. Adv J Emerg Med. 2018;2(3):e29.
11. Fluck R, Kumwenda M. Renal Association Clinical Practice Guideline on vascular access for haemodialysis. Nephron Clin Pract. 2011;118 Suppl 1:c225-40.
12. Tay JC, Sule AA, Chew EK, Tey JS, Lau T, Lee S, et al. Ministry of Health Clinical Practice Guidelines: Hypertension. Singapore Med J. 2018;59(1):17-27.
13. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):iii-iv, 1-72.
14. Rosenfeld RM, Shiffman RN, Robertson P. Clinical Practice Guideline Development Manual, Third Edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2013;148(1 Suppl):S1-55.
15. Rosenfeld RM, Shiffman RN. Clinical practice guideline development manual: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2009;140(6 Suppl 1):S1-43.
16. Lichtenstein DR, Cash BD, Davila R, Baron TH, Adler DG, Anderson MA, et al. Role of endoscopy in the management of GERD. Gastrointest Endosc. 2007;66(2):219-24.
17. Muthusamy VR, Lightdale JR, Acosta RD, Chandrasekhara V, Chathadi KV, Eloubeidi MA, et al. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81(6):1305-10.
18. Krugmann J, Neumann H, Vieth M, Armstrong D. What is the role of endoscopy and oesophageal biopsies in the management of GERD? Best Pract Res Clin Gastroenterol. 2013;27(3):373-85.
19. Safari S, Rahmati F, Baratloo A, Motamedi M, Forouzanfar MM, Hashemi B, et al. Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions&59; a Review Article. Iranian J Emerg Med. 2015;2(1):2-10.
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