Preventing quality improvement drift: evaluation of efforts to sustain the cost savings from implementing best practice guidelines to reduce unnecessary electrocardiograms (ECGs) during the preadmisison testing evaluation.

Self-adoption of best-practice guidelines among clinicians is often poor; however, the barriers to adoption can be overcome with education and individual feedback. Sustaining performance improvement gains is challenging, but possible, as shown by example in one urban, academic teaching hospital's physician-led, NP-staffed outpatient clinic.