Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain

Ann Intern Med. 1995 Mar 15;122(6):434-7. doi: 10.7326/0003-4819-122-6-199503150-00006.


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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Boston
  • Chest Pain / complications
  • Chest Pain / therapy*
  • Communication
  • Coronary Care Units / economics
  • Coronary Care Units / statistics & numerical data
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Hospital Costs
  • Hospitals, Teaching / standards
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Outcome Assessment, Health Care*
  • Patient Admission / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Risk Factors
  • Time Factors
  • Triage / organization & administration*