Medical guideline

Source: Wikipedia, the free encyclopedia.
Not to be confused with Clinical pathway.
Plates vi & vii of the Edwin Smith Papyrus (around the 17th century BC), among the earliest medical guidelines

A medical guideline (also called a clinical guideline, standard treatment guideline, or clinical practice guideline) is a

healthcare. A healthcare provider is obliged to know the medical guidelines of their profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.[4]

Background

Modern clinical guidelines identify, summarize and evaluate the highest quality evidence and most current data about

clinical judgement
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

hospitals
is an effective way of achieving the objectives listed above, although they are not the only ones.

Publication

Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the United States Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines. Healthcare payers such as insurers practicing utilization management also publish guidelines.[5]

Special

electronic medical record
system. The
Guideline Interchange Format (GLIF) is a computer representation format for clinical guidelines that can be used with such engines.[6]

The US and other countries maintain medical guideline clearinghouses. In the US, the National Guideline Clearinghouse maintains a catalog of high-quality guidelines published by various health and medical associations. In the United Kingdom, clinical practice guidelines are published primarily by the National Institute for Health and Care Excellence (NICE). In The Netherlands, two bodies—the Institute for Healthcare Improvement (CBO) and College of General Practitioners (NHG)—have published specialist and primary care guidelines, respectively. In Germany, the German Agency for Quality in Medicine (ÄZQ) coordinates a national program for disease management guidelines. All these organisations are now members of the Guidelines International Network (G-I-N), an international network of organisations and individuals involved in clinical practice guidelines.

Compliance

Checklists have been used in medical practice to attempt to ensure that clinical practice guidelines are followed. An example is the Surgical Safety Checklist developed for the World Health Organization by Dr. Atul Gawande.[7] According to a meta-analysis after introduction of the checklist mortality dropped by 23% and all complications by 40%, but further high-quality studies are required to make the meta-analysis more robust.[8] In the UK, a study on the implementation of a checklist for provision of medical care to elderly patients admitting to hospital found that the checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices, but that work is needed to understand whether and how checklists can be embedded in complex multidisciplinary care.[9]

Problems

Guidelines may lose their clinical relevance as they age and newer research emerges.[10] Even 20% of strong recommendations, especially when based on opinion rather than trials, from practice guidelines may be retracted.[11]

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.

Guidelines may have both methodological problems and conflict of interest.[13] As such, the quality of guidelines may vary substantially, especially for guidelines that are published on-line and have not had to follow methodological reporting standards often required by reputable clearinghouses.[14] Patients and caregivers are frequently excluded from clinical guidelines development, in part because there is a lack of guidance for how to include them in the process.[15]

Guidelines may make recommendations that are stronger than the supporting evidence.[16]

In response to many of these problems with traditional guidelines, the BMJ created a new series of trustworthy guidelines focused on the most pressing medical issues called BMJ Rapid Recommendations.[17]

Examples

See also

References

  1. PMID 12630799
    .
  2. PMID 12571340
    .
  3. ^ Institute of Medicine (edt.) Clinical practice guidelines we can trust. Washington DC, 2011
  4. ^ Council of Europe. Developing a methodology for drawing up guidelines on best medical practice. Recommendation Rec(2001)13 and explanatory memorandum. Strasbourg: Council of Europe Publishing, 2002.
  5. S2CID 11802118
    .
  6. ^ GLIF website
  7. S2CID 2639397
    .
  8. S2CID 22951117
    .
  9. PMID 29315375
    .
  10. PMID 11572738
    .
  11. PMID 24867012
    .
  12. ^ Gina Kolata "Program Coaxes Hospitals to See Treatments Under Their Noses". The New York Times December 25, 2004.
  13. PMID 23752105
    .
  14. PMID 23249447
    .
  15. PMID 28455279
    .
  16. PMID 23783104
    .
  17. ^
    S2CID 32498374
    .
  18. PMID 17446442
    .
  19. PMID 27680583
    .

External links
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