Hospitals in pursuit of excellence

Organizational and Clinical Factors Influencing Use of Clinical Practice Guidelines

Implementing clinical practice guidelines can improve the quality of patient care and positively impact a health care system's bottom line. To increase the chances of successful implementation, a study by Tamara Stone and her colleagues examines ways that guidelines can be tailored to better meet physicians'needs and also suggests strategies that encourage guideline acceptance.

The first phase of the study surveyed almost 500 physicians from four health systems when two guidelines (one for acute myocardial infarction and the other for pediatric asthma) were implemented. Researchers asked physicians exactly where they preferred that the guidelines be placed and what specific learning strategies best encouraged them to use the guidelines. They also asked about the content areas, formats, and types of medical evidence that physicians found most useful as they treated patients.

Survey results revealed that, overall, physicians preferred that guidelines be placed on the front of the patient chart, on their personal palm pilots, or in the progress notes. Discussions with colleagues and continuing medical education were identified as most effective in encouraging guideline implementation. During patient treatment, physicians considered guidelines that included immediate treatment flows and strategies aimed at minimizing and encouraging self-management to be the most useful. Clinical guidelines presented in the form of flowcharts, algorithms and pre-printed orders were also judged more convenient to use when treating patients and randomized controlled trials were the most persuasive medical evidence that could be included in a guideline.