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Background: Guideline development has received considerable attention recently; guideline implementation less. For various reasons, reports of guideline implementations are not common in the published literature. In this paper, we report the results of a multisite quality improvement project undertaken as part of Health Care Financing Administration's Heath Care Quality Improvement Program., Methods: Six acute care hospitals were selected for participation according to the number of procedures during the calendar year 1993. Baseline and postintervention data were abstracted from the medical records of patients having bowel surgery. Performance feedback, education, and process improvement facilitation were the principal interventions used by the investigators; quality improvement plans varied by participant. Baseline and postintervention indicators were calculated., Results: Statistically significant and practically meaningful improvement was observed in the primary indicator and in 4 of 11 subindicators. Conservative estimates indicated modest cost savings., Conclusions: Administration of perioperative antibiotics in bowel surgery can be improved by guideline implementations based on a continuous quality improvement model.