SMC has found that the contents of the guidelines must be available to clinicians during patient consultations or treatments, and that the guideline information must be accessible in a way that does not disrupt the care process (Pragner, 1996, p. 4).
Physician practice guidelines have been developed as part of the quality assurance program at CSMC in relation to chest pain, pneumonia, congestive heart failure, total hip replacement, hip fracture, total knee replacement, upper gastrointestinal hemorrhage, stroke, lumbar laminectomy, and lower gastrointestinal hemorrhage (Weingarten & Ellrodt, 1995, p. 20). The application and effectiveness of two of these guidelines·chest pain and total knee replacement·are assessed in the following discussions.
CSMC developed guidelines to improve the quality and efficiency of medical care for patients hospitalized with chest pain because this symptom may signify the presence of diseases as diverse in prognosis as heartburn to "life-threatening" coronary artery disease and because there are appro
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