LaGrone Lacey N, Stein Deborah M, Wilson Danielle J, Bulger Eileen M, Farley Ashley, Rubiano Andrés M, Michaels Maria, Lane-Fall Meghan B, Person Michael A, Ho Vanessa P, Reinhart Linda, Haut Elliott R
Trauma Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA.
UCHealth, Loveland, Colorado, USA.
Trauma Surg Acute Care Open. 2024 Dec 20;9(1):e001338. doi: 10.1136/tsaco-2023-001338. eCollection 2024.
Thirty-four per cent of deaths among Americans aged 1-46 are due to injury, and many of these deaths could be prevented if all hospitals performed as well as the highest-performing hospitals. The Institute of Medicine and the National Academies of Science, Engineering and Medicine have called for learning health systems, with emphasis on clinical practice guidelines (CPGs) as a means of limiting preventable deaths. Reduction in mortality has been demonstrated when evidence-based trauma CPGs are adhered to; however, guidelines are variably updated, redundant, absent, inaccessible, or perceived as irrelevant. Ultimately, these barriers result in poor guideline implementation and preventable patient deaths. This multidisciplinary group of injury providers, clinical guidance developers and end users, public health and health policy experts and implementation scientists propose key areas for consideration in the definition of an ideal future state for clinical guidance development and dissemination. Suggestions include (1): professional societies collaborate rather than compete for guideline development.(2) Design primary clinical research for implementation, and where relevant, with guideline development in mind.(3) Select clinical topics for guideline development through systematic prioritization, with an emphasis on patient-centered outcomes.(4) Develop guideline authorship groups with a focus on transparency, equity of opportunity and diversity of representation.(5) Establish a plan for regular review and updating and provide the date the guideline was last updated for transparency.(6) Integrate options for adapting the guideline to local resources and needs at the time of development.(7) Make guidelines available on a platform that allows for open feedback and utilization tracking.(8) Improve discoverability of guidelines.(9) Optimize user-experience with a focus on inclusion of bedside-ready, mobile-friendly infographics, tables or algorithms when feasible.(10) Use open access and open licenses.(11) Disseminate clinical guidance via comprehensive and equitable communication channels. Guidelines are key to improve patient outcomes. The proposed focus to ensure trauma guidelines are equitably and effectively developed and disseminated globally.
1至46岁美国人中，34%的死亡是由伤害导致的。如果所有医院都能像表现最佳的医院那样出色，那么其中许多死亡是可以避免的。美国国家医学院以及美国国家科学院、工程院和医学院呼吁建立学习型卫生系统，强调将临床实践指南（CPG）作为减少可预防死亡的一种手段。遵循循证创伤CPG已被证明可降低死亡率；然而，指南更新不及时、冗余、缺失、难以获取或被认为不相关。最终，这些障碍导致指南实施不力，患者可预防死亡。这个由伤害救治人员、临床指南制定者和终端用户、公共卫生和卫生政策专家以及实施科学家组成的多学科团队，提出了临床指南制定和传播理想未来状态定义中需要考虑的关键领域。建议包括：（1）专业学会应合作而非竞争制定指南。（2）设计用于实施的初级临床研究，并在相关情况下考虑指南制定。（3）通过系统排序选择指南制定的临床主题，重点关注以患者为中心的结果。（4）组建指南编写小组，注重透明度、机会公平和代表性多样性。（5）制定定期审查和更新计划，并提供指南上次更新日期以确保透明度。（6）在制定指南时整合根据当地资源和需求调整指南的选项。（7）在一个允许公开反馈和使用跟踪的平台上提供指南。（8）提高指南的可发现性。（9）优化用户体验，尽可能包含便于床边使用、适合移动设备的信息图表、表格或算法。（10）采用开放获取和开放许可。（11）通过全面且公平的沟通渠道传播临床指南。指南是改善患者结局的关键。提议重点确保创伤指南在全球范围内公平、有效地制定和传播。
