1. Clinical Practice Guidelines ….cookbook medicine? Mike Starr Chair, Statewide CPG Steering Group

2. 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

3. Why do we need more? Lots of existing alternatives Textbooks Local Handbooks National Policies Journal Articles Systematic Reviews May be out of date Long winded – not great for point of care use Single author Narrow topic No Local Context

4. Quality Care & Risk Reduction Readily available Up to date Good quality evidence (or consensus) based advice Should be good for quality of care

5. “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

6. What could be useful to an resident or nurse in ED? 10pm Friday Night 15 patients in cubicles 35 more in waiting room Mild Asthma Septic young infant

7. RCH CPG Development Established in 1996 Emergency Department and General Medicine Sub-specialists co-opted as needed Medical & Nursing Seniors and trainees

8. RCH CPG Development Need for individual guidelines identified from: Common paediatric presentations Important paediatric conditions Conditions flagged by problems with individual cases

9. RCH CPG Development

10. Evidence base Point-of-care vs reference Up to date Levels of evidence NOT given Not referenced Reference lists kept

11. Guidelines ~ 400 in total problem-based (eg febrile infant) diagnosis-based (eg pneumonia) procedures (eg nitrous oxide)

12. Review Automatic at 18 months Triggered by critical incident, new evidence, etc Feedback

16. 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

17. 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

21. Evaluation Users Usage - monitoring & survey Site Feedback Patient Outcomes Condition audit Difficulty with pre & post Guideline process incremental Other confounding activities

22. Usage

24. Feedback

26. Clinical Practice Guidelines ….cookbook medicine? Standardised care = better care