Discussion
Summaries
Brown et al. (2007) developed a clinical pathway using a computer support system in an emergency department. This prospective cohort study was targeted at acute transient ischemic attacks (TIA). The clinical pathway was made with guideline recommendations for antithrombotic therapy. 75 subjects were enrolled in this study with a mean age of 67.1. There was almost an even split of males to females (50.7% to 49.3%, respectively). Physician adherence to the pathway was 85.3%. A main point the authors discuss is the physicians that did not follow the clinical pathway described being unsure or uncomfortable when it was advised to discharge the patient. At a 90-day follow up, one patient had suffered a stroke and three patients
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(2010) aimed to implement a computerized clinical decision support for physicians based on Syncope recommendations. This pre-post intervention involved a medical chart review, followed by the computerized clinical support prompting physicians to explain their decisions. Following this, another medical chart review was conducted. There was a significant increase in admission rate from pre-to-post intervention. There was no significant change in CT head imaging rates. When examining a group of physicians who saw ten or more patients during the study, it was revealed that there was a slight significant difference in admission rate from pre-to-post. When evaluating the evidence of this article, it was stated to follow Syncope recommendations and has a high level of consensus. No patient partnerships were disclosed. This study took place at Mount Sinai Medical Center, an academic medical institution. Leadership roles were present and there was audit and feedback throughout (Melnick et al., 2010). Facilitation is once again difficult to comment on as there was little information regarding characteristics. This study scores well on two of the core elements in the framework and could be considered a successful