Towards more effective use of decision support in clinical practice: what the guidelines for guidelines don’t tell you

Scott, Ian A; Denaro, Charles; Bennett, Cameron J; Mudge, Alison

doi:10.1111/j.1445-5994.2004.00604.x

Cited by 21 publications

(27 citation statements)

References 69 publications

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“…The results of this study support previous research that identified that guideline formats and content are important determinants of usability of guidelines in busy clinical environments such as the emergency care sector [11-13]. A survey of multidisciplinary clinicians in Australian public hospitals reported that concise, quick-reference formats were preferred to detailed texts (35% vs. 6%; P < 0.001) [12-14].…”

Section: Discussionsupporting

confidence: 83%

“…This study revealed that 66% of the respondents were unfamiliar with the GRADE system for rating the quality of evidence and recommendations. This is supported by Kotzeva et al [13-15], who reported that clinicians had limited knowledge, experience and understanding of GRADE. This knowledge deficit related to the grading of recommendations is potentially important as a reflection of respondent capacity to recognize and critically evaluate the approach to rating the strength of evidence used by recently developed guidelines.…”

Section: Discussionmentioning

confidence: 72%

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

et al. 2012

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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.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 72%

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

et al. 2012

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“…This is an important message for overcoming possible barriers in implementation of the EBMeDS in a multi-profession context. An Australian study [56] also found that education of professionals and motivation of multidisciplinary groups to redesign care processes can aid in overcoming potential barriers to implementation. In addition, our results reaffirm that needs of nurses and other professionals have to be carefully targeted in the development of automatic reminders for those specific groups [57].…”

Section: Discussionmentioning

confidence: 99%

Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

et al. 2010

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BackgroundFinnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour.MethodsA cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions.ResultsThe results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context- and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals.ConclusionsThe results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.

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“…In light of the above, a predominant focus on catastrophic but infrequent harm and ‘near misses’ that are directly attributable to errors of task execution ignores a much greater reservoir of potential iatrogenesis. Narrowing gaps between best practice and routine care by deploying effective systems of clinical decision support, practice evaluation and care improvement (Table 5) may realize much larger dividends in improved patient outcomes than relying solely on administrative instruments such as sentinel event reporting or risk registers 48–52 …”

Section: Time To Reconsider Basic Tenetsmentioning

confidence: 99%

Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform

Scott

Poole

Jayathissa

2007

Internal Medicine Journal

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Improving quality and safety of hospital care is now firmly on the health-care agenda. Various agencies within different levels of government are pursuing initiatives targeting hospitals and health professionals that aim to identify, quantify and lessen medical error and suboptimal care. Although not denying the value of such 'top-down' initiatives, more attention may be needed towards 'bottom-up' reform led by practising physicians. This article discusses factors integral to delivery of safe, high-quality care grouped under six themes: clinical workforce, teamwork, patient participation in care decisions, indications for health-care interventions, clinical governance and information systems. Following this discussion, a 20-point action plan is proposed as an agenda for future reform capable of being led by physicians, together with some cautionary notes about relying too heavily on information technology, use of non-clinical quality personnel and quantitative evaluative approaches as primary strategies in improving quality.

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Towards more effective use of decision support in clinical practice: what the guidelines for guidelines don’t tell you

Cited by 21 publications

References 69 publications

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

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

Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform

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