ED to catheterization laboratory: A roundtable integrating trials with practice

Charles V. Pollack, Gerard X. Brogan, Marc Cohen, Deborah Diercks, Cindy Grines, Timothy D. Henry, Neal S. Kleiman, Robert P. Giugliano

Research output: Contribution to journalArticle

Abstract

Background: Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at the bedside fit the predefined categories that make guidelines practical. Furthermore, these documents may not incorporate the latest evidence. As a result, other factors (eg, individual patient characteristics, clinician experience, cost, regulatory labels, expert opinions) often result in clinical decision-making that varies from strict adherence to guideline recommendations. Objectives: These challenges demonstrate a need to integrate clinical data and guidelines advice with actual ED practice in a manner that will be consistent with decisions made later in the continuum of care. Discussion: In recognition of these issues, a roundtable was convened in New York City on June 5, 2009, to discuss the implications of recent trials involving patients with non-ST-segment elevation acute coronary syndromes. Eight physicians, representing both emergency medicine and cardiology, shared information on advances and clinical trial results in antiplatelet treatment, guidelines, and other developments in patient care. This article is based on transcripts of their presentations and the ensuing discussions that were of particular importance for emergency physicians. Conclusions: Although guidelines and clinical registries can provide broad direction for practice, there is no substitute for a prospective, multidisciplinary, institution-specific, consistent, evidence-based approach to patient management.

Original languageEnglish (US)
Pages (from-to)1203-1216
Number of pages14
JournalAmerican Journal of Emergency Medicine
Volume29
Issue number9
DOIs
StatePublished - Nov 2011

Fingerprint

Catheterization
Hospital Emergency Service
Guidelines
Clinical Trials
Registries
Physicians
Guideline Adherence
Continuity of Patient Care
Emergency Medicine
Expert Testimony
Acute Coronary Syndrome
Cardiology
Patient Care
Emergencies
Costs and Cost Analysis
Population
Clinical Decision-Making
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Pollack, C. V., Brogan, G. X., Cohen, M., Diercks, D., Grines, C., Henry, T. D., ... Giugliano, R. P. (2011). ED to catheterization laboratory: A roundtable integrating trials with practice. American Journal of Emergency Medicine, 29(9), 1203-1216. https://doi.org/10.1016/j.ajem.2010.08.008

ED to catheterization laboratory : A roundtable integrating trials with practice. / Pollack, Charles V.; Brogan, Gerard X.; Cohen, Marc; Diercks, Deborah; Grines, Cindy; Henry, Timothy D.; Kleiman, Neal S.; Giugliano, Robert P.

In: American Journal of Emergency Medicine, Vol. 29, No. 9, 11.2011, p. 1203-1216.

Research output: Contribution to journalArticle

Pollack, CV, Brogan, GX, Cohen, M, Diercks, D, Grines, C, Henry, TD, Kleiman, NS & Giugliano, RP 2011, 'ED to catheterization laboratory: A roundtable integrating trials with practice', American Journal of Emergency Medicine, vol. 29, no. 9, pp. 1203-1216. https://doi.org/10.1016/j.ajem.2010.08.008
Pollack, Charles V. ; Brogan, Gerard X. ; Cohen, Marc ; Diercks, Deborah ; Grines, Cindy ; Henry, Timothy D. ; Kleiman, Neal S. ; Giugliano, Robert P. / ED to catheterization laboratory : A roundtable integrating trials with practice. In: American Journal of Emergency Medicine. 2011 ; Vol. 29, No. 9. pp. 1203-1216.
@article{a20fc1339a964c9a8885fbb0638aad77,
title = "ED to catheterization laboratory: A roundtable integrating trials with practice",
abstract = "Background: Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at the bedside fit the predefined categories that make guidelines practical. Furthermore, these documents may not incorporate the latest evidence. As a result, other factors (eg, individual patient characteristics, clinician experience, cost, regulatory labels, expert opinions) often result in clinical decision-making that varies from strict adherence to guideline recommendations. Objectives: These challenges demonstrate a need to integrate clinical data and guidelines advice with actual ED practice in a manner that will be consistent with decisions made later in the continuum of care. Discussion: In recognition of these issues, a roundtable was convened in New York City on June 5, 2009, to discuss the implications of recent trials involving patients with non-ST-segment elevation acute coronary syndromes. Eight physicians, representing both emergency medicine and cardiology, shared information on advances and clinical trial results in antiplatelet treatment, guidelines, and other developments in patient care. This article is based on transcripts of their presentations and the ensuing discussions that were of particular importance for emergency physicians. Conclusions: Although guidelines and clinical registries can provide broad direction for practice, there is no substitute for a prospective, multidisciplinary, institution-specific, consistent, evidence-based approach to patient management.",
author = "Pollack, {Charles V.} and Brogan, {Gerard X.} and Marc Cohen and Deborah Diercks and Cindy Grines and Henry, {Timothy D.} and Kleiman, {Neal S.} and Giugliano, {Robert P.}",
year = "2011",
month = "11",
doi = "10.1016/j.ajem.2010.08.008",
language = "English (US)",
volume = "29",
pages = "1203--1216",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "9",

}

TY - JOUR

T1 - ED to catheterization laboratory

T2 - A roundtable integrating trials with practice

AU - Pollack, Charles V.

AU - Brogan, Gerard X.

AU - Cohen, Marc

AU - Diercks, Deborah

AU - Grines, Cindy

AU - Henry, Timothy D.

AU - Kleiman, Neal S.

AU - Giugliano, Robert P.

PY - 2011/11

Y1 - 2011/11

N2 - Background: Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at the bedside fit the predefined categories that make guidelines practical. Furthermore, these documents may not incorporate the latest evidence. As a result, other factors (eg, individual patient characteristics, clinician experience, cost, regulatory labels, expert opinions) often result in clinical decision-making that varies from strict adherence to guideline recommendations. Objectives: These challenges demonstrate a need to integrate clinical data and guidelines advice with actual ED practice in a manner that will be consistent with decisions made later in the continuum of care. Discussion: In recognition of these issues, a roundtable was convened in New York City on June 5, 2009, to discuss the implications of recent trials involving patients with non-ST-segment elevation acute coronary syndromes. Eight physicians, representing both emergency medicine and cardiology, shared information on advances and clinical trial results in antiplatelet treatment, guidelines, and other developments in patient care. This article is based on transcripts of their presentations and the ensuing discussions that were of particular importance for emergency physicians. Conclusions: Although guidelines and clinical registries can provide broad direction for practice, there is no substitute for a prospective, multidisciplinary, institution-specific, consistent, evidence-based approach to patient management.

AB - Background: Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at the bedside fit the predefined categories that make guidelines practical. Furthermore, these documents may not incorporate the latest evidence. As a result, other factors (eg, individual patient characteristics, clinician experience, cost, regulatory labels, expert opinions) often result in clinical decision-making that varies from strict adherence to guideline recommendations. Objectives: These challenges demonstrate a need to integrate clinical data and guidelines advice with actual ED practice in a manner that will be consistent with decisions made later in the continuum of care. Discussion: In recognition of these issues, a roundtable was convened in New York City on June 5, 2009, to discuss the implications of recent trials involving patients with non-ST-segment elevation acute coronary syndromes. Eight physicians, representing both emergency medicine and cardiology, shared information on advances and clinical trial results in antiplatelet treatment, guidelines, and other developments in patient care. This article is based on transcripts of their presentations and the ensuing discussions that were of particular importance for emergency physicians. Conclusions: Although guidelines and clinical registries can provide broad direction for practice, there is no substitute for a prospective, multidisciplinary, institution-specific, consistent, evidence-based approach to patient management.

UR - http://www.scopus.com/inward/record.url?scp=80855129632&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80855129632&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2010.08.008

DO - 10.1016/j.ajem.2010.08.008

M3 - Article

C2 - 20971595

AN - SCOPUS:80855129632

VL - 29

SP - 1203

EP - 1216

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 9

ER -