Survey of preferred guideline attributes: what helps to make guidelines more useful for emergency health practitioners?

Abstract

BackgroundEnhancing CPG acceptance and implementation can play a major role in the development and establishment of emergency medicine as a specialty in many parts of the world. A Guideline International Network special interest group established to support collaboration to improve uptake of clinical practice guidelines (CPGs) across the emergency care sector conducted an international survey to identify attributes of guideline likely to enhance their use.MethodsA Web-based survey was undertaken to determine how CPGs were accessed, the preferred formats and attributes of guidelines, and familiarity with GRADE. The criteria used to identify preferred attributes of guidelines were adapted from the AGREE II Tool.ResultsTwo hundred six responses were received from 31 countries, 74/206 (36%) from the US, 28/206 (16%) from Canada, 17/206 (8%) from Australia and 15/206 (7%) from the UK. The majority of responses were from physicians (176/206, 85%) with 15/206 (7%) of responses from nurses and 9/206 (4%) from pre-hospital emergency services personnel. The preferred format for guidelines was clinical protocols that incorporated recommendations into workflow, and the most preferred attribute of guidelines was the clear identification of key recommendations. The results also identified that within the group that responded to the question related to GRADE, 66% were unfamiliar with this system for summarizing evidence in relationship to recommendations.ConclusionsThe findings provide the basis for further research to explore the most appropriate formats for guidelines or guidelines resources tailored to the needs of the emergency care providers.

A National Survey Identifying the Factors Associated With Cardiovascular Care Nurses' Perceived Knowledge of International Practice Guidelines

“…4,18,19 The majority of participants, who were clinical nurses, cited their knowledge as low, which is contrary to other studies 5,9,20 The personal use of guidelines, defined in this study as having consulted them in the last year, was only achieved by half (50%) of the nurses surveyed, again low compared to other studies 63%-99%. 9,[21][22][23] Differences in usage may in part be a reflection of methodological differences between the studies, for example different method to determine guideline use. Furthermore, a contributing factor may be the sample profile as most participants in this study were clinical nurses, younger, with less experience in cardiovascular care and a lower level of qualification, compared to other studies in the area.…”

Canadian Guidelines for the use of targeted temperature management (therapeutic hypothermia) after cardiac arrest: A joint statement from The Canadian Critical Care Society (CCCS), Canadian Neurocritical Care Society (CNCCS), and the Canadian Critical Care Trials Group (CCCTG)

“…The committee also considered societal values, clinical benefit, risk of harm, cost, feasibility and variations in clinical practice environment. The guidelines were developed using GRADE methodology 7 , with consideration of the AGREE II instrument 14 and guideline attributes most highly valued by emergency health practitioners 169 .…”

When guidelines guide us to harm

“…This reliance on expert consensus in clinical guidelines may lead to prolongation of anecdotal clinical practices that lack sufficient evidence base, but nonetheless retain their authority through codification in a clinical practice guideline. In addition, for guidelines to garner widespread application there needs to be carefully devised methods for dissemination and implementation that promotes usage among the target audience to allow for ready quick‐reference access to end‐users in EDs . Furthermore, it is vital that the impact of the guidelines is regularly audited and reviewed to allow for future improvements to be made to the guideline.…”

“…In addition, for guidelines to garner widespread application there needs to be carefully devised methods for dissemination and implementation that promotes usage among the target audience to allow for ready quickreference access to end-users in EDs. 4,5 Furthermore, it is vital that the impact of the guidelines is regularly audited and reviewed to allow for future improvements to be made to the guideline. This step is crucial to ensure a guideline retains its relevance in line with the latest innovations in evidence-based medicine.…”