Guest Commentary: How to best incorporate guidelines into clinical practice
In this Guest Commentary, Alfred H. Stammers, MSA, CCP, vice president of clinical quality and outcomes research at SpecialtyCare, reviews highlights from his presentation at the 38th Annual Cardiothoracic Surgery Symposium, which focused on the barriers of incorporating guidelines into clinical practice and strategies for improving compliance among perfusionists, surgeons and anesthesiologists.
Clinical practice guidelines are meant to provide the clinician with advice, gleaned from carefully constructed studies in peer-reviewed literature, on how to provide medical and surgical care. They clearly serve a critically important function when they are established with strict methodology using the best available evidence to incorporate what has been shown to improve patient outcomes. Despite the best efforts of organizations that aim to improve quality and optimize patient care, the incorporation of clinical guidelines across practice groups has varied. More often than not, clinical practice guidelines are not being followed accordingly.
Perioperative blood transfusion guidelines are now endorsed by three societies: The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists and the American Society of ExtraCorporeal Technology. More recently, those same three organizations have promoted additional clinical practice guidelines on temperature management for individuals undergoing cardiac surgery for anticoagulation management and for reducing inflammation associated with cardiac surgery. In addition, blood management guidelines are currently being reconstructed and there will be new guidelines for reducing acute kidney injury associated with cardiac surgery.
To improve the incorporation of these clinical guidelines, it will be important to make sure the end users — the clinicians — are involved in their development and have the opportunity to comment on the guidelines before they are published or adopted by the professional societies. Surgeons, perfusionists and anesthesiologists publish guidelines in their primary publications: The Annals of Thoracic Surgery, the Journal of ExtraCorporeal Technology and Anesthesia & Analgesia. In addition to publication, it is important that professional societies conduct periodic reviews of the clinical practice guidelines they endorse. Promoting their growth also requires educational experiences for clinicians so that they understand the aspects of what went into the guideline development, as well as integrating the guidelines into the electronic health records so that they are at the fingertips of clinicians.
Assessing compliance to clinical practice guidelines is challenging but it is critical to determine how often they are being followed and to link them to performance outcome measures. There are very few documented examples of how effectively guidelines are being applied. So, a systematic means that allows analytical determination of successful implementation is something that needs to be established.
In conclusion, for clinical practice guidelines to be effective, they have to follow the standards that were set out by the Institute of Medicine. Patients expect practitioners to use the best available evidence to apply their technologies and techniques to care. Secondarily, the guidelines need to be endorsed by professional societies and then broadly disseminated through publication and on websites of the professional societies so that practitioners who belong to those practice groups can follow them. Finally, it will be critical to conduct quantitative assessments and ensure that clinicians are following the guidelines.
Reference:
Stammers AH. “Why Guidelines Rarely Penetrate the Barriers of Clinical Practice.” Presented at: The Annual Cardiothoracic Surgery Symposium; Sept. 6-9, 2018; San Diego.
Disclosure: Stammers reports no relevant financial disclosures.