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December 24, 1997

Using a Practice Guideline for Safely Shortening Hospital Stay for Upper Gastrointestinal Tract Hemorrhage

Author Affiliations

From the Department of Medicine, University of Texas Southwestern Medical School at Dallas and Medical Service, Department of Veterans Affairs Medical Center, Dallas (Dr Peterson), and the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Dr Cook).

JAMA. 1997;278(24):2186-2187. doi:10.1001/jama.1997.03550240076039

Making optimal medical decisions within the constraints of a given health care system requires integrating knowledge, experience, compassion, and patient preferences with the best available clinical research. Evidence-based practice guidelines are an increasingly popular means of helping clinicians assimilate research results into practice. In this issue of JAMA, Hay and colleagues1 describe a practice guideline developed to determine the time of discharge for patients admitted with acute, nonvariceal upper gastrointestinal tract hemorrhage. In preparing this length-of-stay guideline, these investigators used observational studies from the literature and their own database to create and retrospectively validate a risk-stratification model incorporating 4 variables to predict the likelihood of further bleeding: findings at endoscopy, time elapsed from onset of bleeding, hemodynamics, and comorbidities.2

See also p 2151.

The goal of this and other practice guidelines is to influence some aspect of patient care through modification of clinician behavior. However, it has long