Cost-effective medicine: the financial impact that practice guidelines have on outpatient hospital charges in the emergency department.

The objective of this study was to determine whether specific cost-effective guidelines based on a patient's chief complaint can significantly reduce outpatient hospital charges in the ED. A prospective randomized single-blinded clinical trial was conducted in an urban community hospital ED with a 14,000 annual census. The first phase of the study involved preintervention data collection. The second phase focused on development, physician approval, and implementation of 23 specific cost-effective guidelines, as well as general recommendations for diagnostic tests. The third phase involved postintervention data collection. Results showed that the total outpatient hospital charge decreased by 28% per patient. The laboratory hospital charge decreased by 46% per patient. The radiology hospital charge decreased by 20% per patient. The hospital supply charge and pharmacy charge decreased by 31% per patient and 11% per patient, respectively. In conclusion, cost-effective medicine practiced with specific guidelines, based on a patient's chief complaint, significantly reduces unnecessary diagnostic tests and medical treatments ordered by emergency physicians.