In measuring and attempting to improve physician compliance with a length-of-stay guideline, physician refusal accounts for a small percentage (16%) of noncompliance. Implementation issues, health care system inefficiency, and severity of illness were the predominant reasons why physicians did not comply with guidelines. Our study further supports the principle that clinical practice guidelines should complement rather than be a substitute for physician judgment.
The authors assessed whether the lack of weekend cardiac test availability significantly contributed to weekend delays in hospital discharge for "low-risk" chest pain patients. Mean lengths of stay were compared for late-week versus early-week admissions. Patients with late-week admissions had a 19% greater length of stay than did patients admitted earlier in the week (2.36 +/- 1.87 vs 1.91 +/- 1.21 days, p = 0.10, with p = 0.015 after adjusting for severity of illness). Cardiac diagnostic tests were ordered for only 4% of study patients. Therefore, the "weekend effect" existed in an environment where cardiac diagnostic tests were infrequently ordered.
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