Susan E Harris | PubMed Health

PubMed2003

Impact of a chest-pain guideline on clinical decision-making.

OBJECTIVE: To evaluate the impact of a chest-pain guideline on clinical decision-making and medium-term outcomes of patients presenting to a hospital emergency department (ED) with non-traumatic chest pain. DESIGN: Before-and-after guideline implementation study. SETTING: Bankstown-Lidcombe Hospital, Sydney, NSW (454-bed metropolitan teaching hospital), in the six-month periods before and after guideline implementation in February 2001. PARTICIPANTS: Patients presenting to the ED with non-traumatic chest pain who had chest-pain assessment forms completed by ED doctors, comprising 422/768 (54.9%) of those presenting before and 461/691 (66.7%) after guideline implementation. MAIN OUTCOME MEASURES: Appropriateness of admission/discharge decisions compared with decision of senior cardiologist based on guideline; death, recurrent chest pain, ED re-presentation and hospital readmission in the ensuing three months. RESULTS: After guideline implementation, appropriate admission/discharge decisions increased significantly from 180/265 (68%) to 261/324 (81%) (difference, 13%; 95% CI, 6%-20%). The largest increase was for patients at moderate risk of death or acute myocardial infarction within six months, from 39/96 (38%) to 57/103 (55%) (difference, 18%; 95% CI, 4%-31%). Increases were seen for both junior doctors (interns and resident medical officers) (18%; 95% CI, 7%-30%) and senior doctors (11%; 95% CI, 2%-19%). Logistic regression showed that implementation of the guideline, seniority of assessing doctor and patient history of coronary disease were independent predictors of appropriate decisions. There was a significant decline in re-presentations to ED with recurrent chest pain in patients previously presenting with cardiac or possibly cardiac pain, from 46/201 (23%) before implementation to 32/247 (13%) after (difference, 210%; 95% CI, 217% to 23%). CONCLUSIONS: The chest-pain guideline resulted in a significant improvement in clinical decision-making in the ED and reduced re-presentations with cardiac/possibly cardiac chest pain.

Angina Pectoris↗

PubMed2002

Satisficing in hypothesis generation.

Research in hypothesis generation suggests that people might act as satisficers and be less likely to generate plausible alternative hypotheses when they already have a hypothesis that accounts for the data in hand. Three experiments simulated scientific hypothesis development. In all 3, participants who had been given a hypothesis consistent with available data generated proportionally fewer of the simplest alternative hypotheses than participants given no such satisficing hypothesis. Furthermore, participant satisficing occurred regardless of whether the provided hypothesis was generated a priori or post hoc and despite high incentives for completeness. Limitations and implications of these findings are discussed for hypothesis development and the practice of taking post hoc hypotheses suggested by one's results and presenting them as a priori hypotheses.

Humans↗