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A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions and criteria in specific areas of healthcare, as defined by an authoritative examination of current evidence (evidence-based medicine). Guidelines usually include summarized consensus statements, but unlike the latter, they also address practical issues.
Clinical guidelines briefly identify, summarize and evaluate the best evidence and most current data about prevention, diagnosis, prognosis, therapy, risk/benefit and cost/effectiveness. Then they define the most important questions related to clinical practice and identify all possible decision options and their outcomes. Thus, they integrate the identified decision points and respective courses of action to the clinical judgment and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use.
Additional objectives of clinical guidelines are to standardize medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the healthcare provider, to medical insurers and health plans) and to achieve the best balance between cost and medical parameters such as effectiveness, specificity, sensitivity, resolutiveness, etc.
The guideline-based approach to healthcare is a relatively recent one and has originated in the United States in the 90s. Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the US Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines. It has been demonstrated repeatedly that the use of guidelines by healthcare providers such as hospitals is an effective way of achieving the objectives listed above, although they are not the only ones.
Special computer software packages have been developed to facilitate the production and use of medical guidelines. (guideline execution engine). Healthcare workflow is concerned with coordinating task done by different personel. On-line medical literature databases (such as PubMed) and evidence-based medicine databases (such as the Cochrane Collaboration), and printed and electronic publications exist in large numbers for this purpose. The USA and other countries maintain medical guideline clearinghouses. Clinical guidelines may include or not decision or calculation algorithms.
It has been found that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a nurse or other medical assistant with a checklist of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.
In the USA, the National Guideline Clearinghouse produces guidelines. In the United Kingdom, this task is performed by the National Institute for Health and Clinical Excellence (NICE). In The Netherlands, two bodies (CBO and NHG) publish specialist and primary care guidelines, respectively.
See also[edit | edit source]
- Medical decision making
- Evidence-based medicine
- Consensus (medical)
- Algorithm (medical)
- Clinical protocol (cf. first line of the present article)
Reference[edit | edit source]
- ^ Gina Kolata Program Coaxes Hospitals to See Treatments Under Their Noses. New York Times December 25, 2004. Article (site requires registration and payment of a fee).
- Fischer B, Simanski C on behalf of the PROSPECT Working Group. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 2005; 60: 1189–1202. Data tables
- Fischer B, Simanski C on behalf of the PROSPECT Working Group. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 2005; 60: 1189-1202. Abstract
- Gray A, Kehlet H, Bonnet F, Rawal N. Predicting postoperative analgesic outcomes: NNT league tables or procedure-specific evidence? Br J Anaesth 2005; 94 (6): 710–14. Abstract
- Kehlet H, Gray A, Bonnet F, Camu F, Fischer BJ, McCloy RF, Neugebauer EAM, Puig MM, Rawal N, Simanski CJP. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 2005; 19 (10): 1396–415. Abstract
- Kehlet H, Wilkinson R, Fischer HBJ, Camu F, on behalf of the PROSPECT Working Group. PROSPECT: Evidence-based, procedure-specific postoperative pain management. Best Practice and Research: Clinical Anaesthesiology. 2007; 21 (1): 149-159. Abstract
- Kehlet, H. Procedure-specific postoperative pain management. Anesthesiol Clin North America. 2005; 23(1): 203-10. Abstract
- Neugebauer E, Wilkinson R, Kehlet H, on behalf of the PROSPECT Working Group. Transferable Evidence in Support of Reaching a Consensus. German Journal for Evidence and Quality in Healthcare Special issue: ‘Guidelines and Consensus' . Z.ärztl.Fortbild.Qual.Gesundh. 2007;101:103-107. Abstract
- Neugebauer E, Wilkinson R, Kehlet H, Schug S, on behalf of the PROSPECT Working Group. PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain. Surgical Endoscopy 2007 (Epub ahead of print). Abstract
[edit | edit source]
- National Guideline Clearinghouse™ (NGC), a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services
- The Cochrane Collaboration
- Guideline Interchange Format. The Guideline Interchange Format (GLIF) is a specification for structured representation of guidelines.
- Guideline Elements Model. The Guideline Elements Model (GEM) is an ASTM standard for the representation of practice guidelines in XML format.
- 2004 report Hospital Quality Alliance (HQA), a project of the Hospital Quality Initiative (HQI) of the Centers for Medicare & Medicaid Services (CMS)
- [hppt://www.postoppain.org] An interesting practical application can be seen at which contains recommendations for best practice procedure specific post operative pain management. The programme is known as PROSPECT.
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