Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 8;4(2):e153.
doi: 10.1097/pq9.0000000000000153. eCollection 2019 Mar-Apr.

A Framework for Maintenance and Scaling of an Evidence-based Guideline Program

Annie Seneski  1 , Anne M Stack  1
Affiliations

A Framework for Maintenance and Scaling of an Evidence-based Guideline Program

Annie Seneski et al. Pediatr Qual Saf. .

Abstract

Introduction: Use of Evidence-based Guidelines (EBGs) has been shown to improve and standardize care. After implementation and maturation of a guideline program, next steps include incorporating new evidence, sustaining adherence, minimizing measurement burden and fostering scaling of the program. We propose a framework for maintenance and dissemination of an EBG program.

Methods: Using a program of 28 EBGs developed for use in a pediatric emergency department (ED) in 2010, we developed: a framework for iterative review and revision, a strategy to measure ongoing use in practice and an approach for minimizing repeated measurement sufficient to evaluate outcomes. Also, we created a process to spread the EBG program to the hospital's Department of Pediatrics.

Results: The framework for maintenance and spread of a program of EBGs resulted in an annual review of individual guidelines with 14 revisions warranted by new evidence, some leading to decreased medication utilization and hospitalization rates. We demonstrated adherence to key quality measures, and decreased the number of measures from 89 to 43, retiring 46 measures with stable peformance. We spread the process for program development to the hospital pediatric department resulting in 36 new EBGs.

Conclusions: We developed a framework for maintenance and scale of a program of EBGs. Our key learning points were that regular incorporation of new evidence, assessment and feedback on performance and leadership with administrative support are necessary to maintain improvement. This framework may assure sustainability and inform other guideline programs. We offer processes to promote guideline dissemination within an academic hospital.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Driver diagram for maintaining and scaling of an EBG program. MUSIQ, Model for Understanding Success in Quality.
Fig. 2.
Fig. 2.
Example of EBG. This guideline was developed for educational purposes only and for use in the Division of Emergency Medicine program at Boston children’s Hospital. Decisions about evaluation and treatment are the responsibility of the treating clinician and should always be tailored to individual clinical circumstances. This image © Department of Medicine/Boston Children’s Hospital. This image was republished with permission of the Department of Medicine/Boston Children’s Hospital. Permission from the copyright holder is required for reuse. EKG, electrocardiogram; hCG, human chorionic gonadotropin; SLE, systemic lupus erythematosus;IBD- inflammatory bowel disease; JRA- juvenile reactive arthritis;EDS- Ehlers-Danlos syndrome;CXR, chest x-ray; GI, gastrointestinal; PE, pulmonary embloism; AV, atrioventricular; PVC, Premature ventricular contraction.
Fig. 3.
Fig. 3.
Timeline of reduction in EBG measurement frequency
Fig. 4.
Fig. 4.
EBG governance structure. DoP, Department of Pediatrics; MD, doctor of medicine; RN, registered nurse.
Fig. 5.
Fig. 5.
Framework for measurement strategy for a program of EBGs. PDSA.
See this image and copyright information in PMC

References

    1. Lohr KN, Field MJ; Institute of Medicine, Committee to Advise the Public Health Service on Clinical Practice Guidelines. Clinical Practice Guidelines : Directions for a New Program. 1990. Washington (DC): National Academies Press (US), https://books.google.com/books/about/Clinical_Practice_Guidelines.html?i.... Accessed November 16, 2017. - PubMed
    1. Venkatesh AK, Savage D, Sandefur B, et al. Systematic review of emergency medicine clinical practice guidelines: implications for research and policy. PLoS One. 2017;12:e0178456 doi: 10.1371/journal.pone.0178456. - PMC - PubMed
    1. Akenroye AT, Stack AM. The development and evaluation of an evidence-based guideline programme to improve care in a paediatric emergency department. Emerg Med J. 2016;33:109–117. - PubMed
    1. Cincinnati Children’s Hospital. Evidence-Based Care Recommendations. Available at https://www.cincinnatichildrens.org/service/j/anderson-center/evidence-b.... Accessed November 15, 2017.
    1. Seattle Children’s Hospital. Clinical Standard Work Pathways and Tools. Available at http://www.seattlechildrens.org/healthcare-professionals/gateway/pathways/. Accessed November 15, 2017.