Transcript Clinical Practice Guidelines

Clinical
Practice
Guidelines
….cookbook
medicine?
Mike Starr
Chair, Statewide CPG Steering Group
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
Textbooks
Local Handbooks
National 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May be out of date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 Night
15 patients in cubicles
35 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
CPG meeting
Consult with
2nd group
member
Revision
Consult with
other
appropriate
groups
CPG sign off
Formatted
Published
Review
process
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)
Review
• Automatic at 18 months
• Triggered by critical incident, new evidence, etc
• Feedback
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
Usage
Usage
Feedback
Clinical
Practice
Guidelines
….cookbook
medicine?
Standardised care = better care