Clinical Practice Guidelines

….cookbook medicine?

Mike StarrChair, 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

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May be out of date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

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 Night15 patients in cubicles35 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

RevisionConsult with 2nd group

member

Consult with other

appropriate groups

CPG meeting

CPG sign off

Formatted

Review process

Published

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