The effectiveness of local adaptation of nationally produced clinical practice guidelines

Silagy, C; Weller, D P; Lapsley, Helen; Middleton, Philippa; Shelby‐James, Tania; Fazekas, Belinda

doi:10.1093/fampra/19.3.223

Cited by 45 publications

(41 citation statements)

References 12 publications

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“…Most hospitals do not have the resources to thoroughly develop CPGsleaving pre-existing CPGs as the most feasible option [34] . Even when adopting existing CPGs, many interview subjects confirmed earlier findings that CPGs need to be adapted to local factors within each institution to promote uptake [34][35][36][37] . However, this research demonstrates that adaptation could impede the CPG-LOS relationship.…”

Section: Relation To Other Findingsupporting

confidence: 59%

The impact of acute care clinical practice guidelines on length of stay: A closer look at some conflicting findings

Ellen

Baker

Brown

2014

JHA

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Systematic reviews have found that clinical practice guidelines (CPGs) are associated with lower lengths of stay (LOS), but a secondary analysis of Ontario acute care hospitals found few significant relationships between CPGs and LOS. This research explored possible reasons for these findings and what other factors may impact the CPG-LOS relationship. Semi-structured interviews were conducted with staff from nine hospitals whose jobs dealt with developing, implementing, monitoring, updating, or evaluating CPGs. Interviews were analyzed utilizing methods outlined by Aurebach. A variety of leaders and hospital types were represented. Five main factors influencing relationships between CPGs and LOS were identified: 1) the purpose of implementation, 2) evidence base for CPG content and selection, 3) health care professionals' response to change and compliance, 4) dissemination strategies, and 5) organizational support and resources. The interviews suggested possible reasons why CPGs are not realizing their full potential impact on LOS in Ontario hospitals, ranging from poor compliance to resistance from health care providers. CPGs themselves are not perceived to be the reason for ineffectiveness; rather, organizational-and individual-level barriers seem to be the causes.

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Section: Relation To Other Findingsupporting

confidence: 59%

The impact of acute care clinical practice guidelines on length of stay: A closer look at some conflicting findings

Ellen

Baker

Brown

2014

JHA

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“…In addition, local adaptation of international guidelines is expensive, and not in itself a guarantee that they will be applied [24].…”

Section: Discussionmentioning

confidence: 99%

Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation

Wasserfallen

Berger²,

Eckert³

et al. 2004

International Journal for Quality in Health Care

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Objective. To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment.Design. Prospective before-after evaluation over a 3-month period.Setting. The emergency ward of a tertiary teaching hospital.Patients. All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods.Intervention. Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team.Main outcome measures. Diagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation.Results. The clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment.Conclusion. Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.

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“…3 The last decade has seen a proliferation of evidence-based clinical practice guidelines. 4 Antibiotic guidelines and associated interventions have been demonstrated to be effective in improving antibiotic use. 5 Organizations that have promulgated guidelines for antimicrobial prophylaxis in cardiac surgery include the National Surgical Infection Prevention Project (NSIPP), 6 the Society of Thoracic Surgeons (STS), 1,3 and the American College of Cardiology/American Heart Association (ACC/AHA).…”

Section: Adherence To International Antimicrobial Prophylaxis Guidelimentioning

confidence: 99%

Adherence to International Antimicrobial Prophylaxis Guidelines in Cardiac Surgery: A Jordanian Study Demonstrates Need for Quality Improvement

Al-Momany¹,

Al‐Bakri²,

Makahleh³

et al. 2009

JMCP

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BACKGROUND: Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection (SSI). Inappropriate antimicrobial prophylaxis, such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen, can increase the prevalence of antibiotic resistant strains, prolong hospital stay, cause adverse reactions, and negatively affect an institution's pharmacy budget for antibiotics. In developing countries such as Jordan, where the role of clinical pharmacists is still in its primary stages, the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement.

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The effectiveness of local adaptation of nationally produced clinical practice guidelines

Cited by 45 publications

References 12 publications

The impact of acute care clinical practice guidelines on length of stay: A closer look at some conflicting findings

The impact of acute care clinical practice guidelines on length of stay: A closer look at some conflicting findings

Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation

Adherence to International Antimicrobial Prophylaxis Guidelines in Cardiac Surgery: A Jordanian Study Demonstrates Need for Quality Improvement

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