Clinical Practice Guidelines ….cookbook medicine?
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Clinical Practice Guidelines
….cookbook medicine?
Mike StarrChair, Statewide CPG Steering Group
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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
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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May be out of date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
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Quality Care & Risk Reduction
• Readily available
• Up to date
• Good quality evidence (or consensus) based advice
• Should be good for quality of care
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“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
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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
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RCH CPG Development
• Established in 1996
• Emergency Department and General Medicine
• Sub-specialists co-opted as needed
• Medical & Nursing
• Seniors and trainees
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RCH CPG Development
Need for individual guidelines identified from:
• Common paediatric presentations
• Important paediatric conditions
• Conditions flagged by problems with individual cases
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RCH CPG Development
Initial Draft
RevisionConsult with 2nd group
member
Consult with other
appropriate groups
CPG meeting
CPG sign off
Formatted
Review process
Published
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Evidence base
• Point-of-care vs reference• Up to date
• Levels of evidence NOT given• Not referenced• Reference lists kept
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Guidelines
~ 400 in total• problem-based (eg febrile infant)• diagnosis-based (eg pneumonia)• procedures (eg nitrous oxide)
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Review
• Automatic at 18 months
• Triggered by critical incident, new evidence, etc
• Feedback
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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
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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
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Evaluation
Users• Usage - monitoring & survey• Site Feedback
Patient Outcomes• Condition audit• Difficulty with pre & post• Guideline process incremental• Other confounding activities
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Usage
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Usage
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Feedback
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Clinical Practice Guidelines
….cookbook medicine?
Standardised care = better care