Post on 21-Dec-2015
Clinical Practice Guidelines
• A means to deliver evidence-based and/or consensus best-practice recommendations to clinicians
• CPGs can aid clinicians in providing optimal care to patients
Why do we need more?Lots of existing alternatives
TextbooksLocal HandbooksNational Policies Journal Articles Systematic Reviews
May be out of date
Long winded – not great for point of care use
Single author
Narrow topic
No Local Context
Quality Care & Risk Reduction
• Readily available
• Up to date
• Good quality evidence (or consensus) based advice
• Should be good for quality of care
“Guidelines are a constructive response to the reality that practicing physicians require assistance to assimilate and apply the exponentially expanding, and often contradictory, body of medical knowledge” Allan Sniderman, Curt Furberg, JAMA
Research → Clinical Practice
5-10 years
What could be useful to an resident or nurse in ED?10pm Friday Night15 patients in cubicles35 more in waiting room
Mild Asthma Septic young infant
RCH CPG Development
• Established in 1996
• Emergency Department and General Medicine
• Sub-specialists co-opted as needed
• Medical & Nursing
• Seniors and trainees
RCH CPG Development
Need for individual guidelines identified from:
• Common paediatric presentations
• Important paediatric conditions
• Conditions flagged by problems with individual cases
RCH CPG Development
Initial Draft
RevisionConsult with 2nd group
member
Consult with other
appropriate groups
CPG meeting
CPG sign off
Formatted
Review process
Published
Evidence base
• Point-of-care vs reference• Up to date
• Levels of evidence NOT given• Not referenced• Reference lists kept
Guidelines
~ 400 in total• problem-based (eg febrile infant)• diagnosis-based (eg pneumonia)• procedures (eg nitrous oxide)
Statewide guidelines
• DoH Paediatric Clinical Network set up Statewide CPG steering group in 2011
• Aim: set of statewide guidelines for the management of a number of common and/or important paediatric conditions
• RCH CPGs to be used as the basis
Statewide guidelines
• Development group expanded to be more representative
• Monash Children’s, metropolitan hospitals, regional, rural, GP, Nurse Practitioner
• RCH CPGs modified to make them more relevant as statewide guidelines – new template, advice regarding consultation and referral
Evaluation
Users• Usage - monitoring & survey• Site Feedback
Patient Outcomes• Condition audit• Difficulty with pre & post• Guideline process incremental• Other confounding activities