• Jean-Blaise Wasserfallen, Alexandre Berger, Philippe Eckert, Jean-Christophe Stauffer, Jürg Schlaepfer, Dominique Gillis, Jacques Cornuz, Marie-Denise Schaller, Lukas Kappenberger, and Bertrand Yersin.
• Internal Medicine, University Hospital (CHUV), CH-01011 Lausanne, VD, Switzerland. jwasserf@chuv.hospvd.ch
• Int J Qual Health Care. 2004 Oct 1; 16 (5): 383-9.

ObjectiveTo assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment.DesignProspective before-after evaluation over a 3-month period.SettingThe emergency ward of a tertiary teaching hospital.PatientsAll consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods.InterventionImplementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team.Main Outcome MeasuresDiagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation.ResultsThe clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment.ConclusionGuidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.

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