Updates to the ACCF/AHA and ESC STEMI and NSTEMI guidelines: putting guidelines into clinical practice.

The publication of consensus group guidelines provides an opportunity to standardize practices through evidence-based protocols. Variations in patient care have been shown to result in disparities in patient outcomes, whereas protocols streamline the clinical decision-making process and reduce variation. 1 By enhancing the speed and accuracy of evaluation and treatment, efficiency can be optimized and outcomes improved. 2 Clinical protocols were first applied to the management of acute coronary syndromes (ACS) in the 1990s through algorithms used to manage patients with acute chest pain. 3 Effective protocols have since emerged as a means to improve patient outcomes by standardizing and coordinating care from presentation to postdischarge and subsequent follow-up. 4,5 Although protocols can serve as a useful guide for providers, modifying care according to individual patient characteristics and specific clinical situations is essential to ensure appropriate provision of care. The goals of an effective protocol are to define standards of practice (informed by clinical practice guidelines), reduce unnecessary variability, coordinate different aspects of care, enhance efficiency, and improve the quality of care. 6e8 In this report, we review important considerations and challenges in creating institution-specific protocols for patients with ACS informed by consensus guidelines. We further present a concrete example from our institutional experience of implementing an ACS protocol and conclude by describing the critical role of registry-based reporting for continuous feedback and quality improvement after protocol implementation.