2The resistance to changing guidelines – what are the challenges and how to meet them
Section snippets
Definition of clinical guidelines
According to Field and Lohr:13 ‘clinical guidelines are systematically developed statements to assist practitioner or patient decisions about appropriate health care for specific clinical circumstances’. They are based on the best available scientific evidence to provide clinicians with guidance to ensure that best practice is offered to patients.3 Guidelines are supposed to evaluate the wealth of scientific data, clarify different points of view, and finally define state-of-the-art procedures.
The process of change: the case of preoperative fasting
Unlike the field of industry, where people are forced to bring new ideas into practice because of fierce economic competition, it seems that within health systems the issue of ‘how to make guidelines work’ has always played a minor role.12, 17 As a consequence, data concerning the implementation process of liberalized guidelines for preoperative fasting are rare. Nevertheless, since several anaesthesiology societies from different countries have officially changed their recommendations for
Summary
As we have seen, clinical guidelines are meant to facilitate best medical practice. One might therefore expect them to be widely used. However, research has shown that the existence of an excellent guideline guarantees neither its wide nor its consistent use. Besides the efforts being made in developing guidelines, a lot more has to be done to encourage their implementation. Identifying the vast number of obstacles to any change in clinical practice is a decisive part of an implementation
References (68)
- et al.
Building a framework for getting evidence into critical care education and practice
Intensive & Critical Care Nursing
(2000) - et al.
Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations
Lancet
(1993) - et al.
From best evidence to best practice: effective implementation of change in patients' care
Lancet
(2003) Translating practice guidelines into patient care: guidelines at the bedside
Chest
(2000)- et al.
Health policy issues and applications for evidence-based medicine and clinical practice guidelines
Health Policy
(1998) - et al.
Preoperative oral carbohydrate administration reduces postoperative insulin resistance
Clinical Nutrition
(1998) - et al.
Assessing health quality – the case for tracers
The New England Journal of Medicine
(1973) - et al.
Der Internist
(2001) To Err is Human
(1999)- et al.
The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality
Journal of the American Medical Association
(1998)
How good is the quality of health care in the United States?
The Milbank Quarterly
Barriers to translating evidence into practice
Current Opinion in Critical Care
What drives change? Barriers to and incentives for achieving evidence-based practice
The Medical Journal of Australia
Acting on the Evidence
Beliefs and evidence in changing clinical practice
British Medical Journal
Guidelines for Clinical Practice: From Development to Use
Kritische Bewertung von Leitlilnien
Evidence based medicine: what it is and what it isn't
British Medical Journal
The Development and Implementation of Quality and Improvement System (QIS) in Health Care – Recommendation
Clinical guidelines to improve patient care
The Netherlands Journal of Medicine
Healthcare rationing-are additional criteria needed for assessing evidence based clinical practice guidelines?
British Medical Journal
Barriers and bridges to evidence based clinical practice
British Medical Journal
Why don't medical textbooks teach? The lack of logic in the differential diagnosis
The Netherlands Journal of Medicine
Wie ließe sich die ärztliche Behandlung der Kranken angesichts der jetzigen wirtschaftlichen Notlage der Bevölkerung sparsam und doch sachgemäß gestalten?
Deutsche Medizinische Wochenschrift
Introduction: the philosophy of evidence based medicine
Closing the gap between research and clinical practice
Topics in Stroke Rehabilitation
No magic bullets: a systematic review of 102 trials of interventions to improve professional practice
CMAJ: Canadian Medical Association Journal
Attributes of clinical guidelines that influence use of guidelines in general practice: observational study
British Medical Journal
Consensus methods: characteristics and guidelines for use
American Journal of Public Health
Evidence-based disease management
Journal of the American Medical Association
Effects of feedback of information on clinical practice: a review
British Medical Journal
Framework for guidelines implementation studies
Why don't physicians follow clinical practice guidelines? A framework for improvement
Journal of the American Medical Association
An overview of strategies to promote implementation of evidence-based health care
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2016, American Journal of Emergency MedicinePreoperative fasting guidelines: An update
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2015, Anesthesiology Clinics