Renvoize E B, Hampshaw S M, Pinder J M, Ayres P
General Infirmary at Leeds, Leeds, UK.
Qual Health Care. 1997 Dec;6(4):187-91. doi: 10.1136/qshc.6.4.187.
To assess the attitudes of senior hospital staff towards clinical guidelines, and to ascertain the perceived extent and benefits of their local use; to identify those hospitals with current or planned future written strategies for the systematic development of clinical guidelines, and the staff responsible for leading them; and to establish the essential elements of existing strategies, and the methods used to ensure the proper development, dissemination, implementation, and evaluation of local guidelines.
Cross sectional survey.
Senior staff of 270 acute hospitals in the United Kingdom (response rate 202/270 (75%)) in 1995.
197/199 (99%) of respondents thought that clinical guidelines were a good idea, and 176/196 (90%) were aware of some guideline activity occurring within their hospitals. The most important benefits of local guideline activity were increased healthcare efficiency and effectiveness, greater consistency of treatment, and team building. 174/194 (90%) of respondents were in favour of the development of a readily accessible national repository of evidence-based clinical guidelines. 38/201 (19%) of respondents had a clinical guidelines strategy and a further 91/201 (45%) said that they had plans to develop one in the near future. The need to improve clinical outcomes was most often reported as the reason for developing a strategy. Medical directors most commonly had formal responsibility to lead the strategy, but someone without formal responsibility ran the operation in half the hospitals. Only 18/36 (50%) of strategies gave advice on the development of guidelines; and only a few strategies made explicit statements on which clinical services to target for guideline development, or the methods to be used for their validation and promotion. Some strategies lacked explicit statements on methods to monitor adherence, routine review, and update of guidelines. Internal literature searches (29/31 (94%)), the use of national guidelines (29/32 (91%)), local consensus conferences (28/32 (88%)), and peer group review (21/24 (88%)) were the most popular methods of validation used in hospitals with a strategy. Methods used to promote the dissemination, implementation, and evaluation of clinical guidelines included clinical audit (31/32 (97%)), peer review (25/30 (83%)), continuing education (23/29 (79%)), targeting of opinion leaders (17/26 (65%)), use of structured case notes (14/31 (45%)), patient mediated interventions (9/26 (35%)), and patient specific reminders (8/26 (31%)).
Most senior hospital staff have a favourable attitude towards clinical guidelines. Most hospitals are undertaking some guideline activity, but few seem to be doing so within a locally agreed hospital wide strategy in which guideline development, dissemination, implementation, and evaluation are systematically considered. Many of the current methods used to validate guidelines locally are inadequate. Evidence-based clinical guidelines should be developed nationally, leaving hospitals to focus their energies on the local adaptation, dissemination, implementation, and evaluation of such guidelines. Only in this way will local guidelines achieve their full potential to improve clinical care and patient outcomes.
评估医院高级职员对临床指南的态度，确定他们对当地使用临床指南的认知程度和益处；找出那些拥有当前或计划在未来制定临床指南系统发展书面策略的医院，以及负责领导这些策略的职员；确定现有策略的基本要素，以及用于确保当地指南得到妥善制定、传播、实施和评估的方法。
横断面调查。
1995年英国270家急症医院的高级职员（回复率为202/270（75%））。
197/199（99%）的受访者认为临床指南是个好主意，176/196（90%）知晓其医院内有一些指南相关活动。当地指南活动最重要的益处是提高医疗保健效率和效果、增强治疗的一致性以及团队建设。174/194（90%）的受访者支持建立一个易于获取的基于证据的临床指南国家知识库。38/201（19%）的受访者有临床指南策略，另有91/201（45%）表示他们计划在不久的将来制定一个。最常被报告的制定策略的原因是需要改善临床结果。医疗主任最常正式负责领导该策略，但在一半的医院中，是由没有正式职责的人来运作。只有18/36（50%）的策略对指南制定提供建议；只有少数策略明确指出针对哪些临床服务进行指南制定以及用于验证和推广指南的方法。一些策略缺乏关于监测指南依从性、定期审查和更新的明确方法说明。内部文献检索（29/
