The development and evaluation of an evidence-based guideline programme to improve care in a paediatric emergency department

• Published in: Emergency medicine journal : EMJ Vol. 33; no. 2; p. 109
• Main Authors: Akenroye, Ayobami T, Stack, Anne M
• Format: Journal Article
• Language: English
• Published: England 01-02-2016
• Subjects: Boston; Emergency Service, Hospital - standards; Evidence-Based Medicine; Guideline Adherence; Hospitals, Urban; Humans; Organizational Culture; Pediatrics - standards; Practice Guidelines as Topic; Program Development; Program Evaluation; Quality Improvement; Surveys and Questionnaires; emergency care systems, efficiency; paramedics, guidelines; emergency care systems; paediatric emergency med; emergency department
• ISSN: 1472-0213
• DOI: 10.1136/emermed-2014-204363

Care guidelines can improve the quality of care by making current evidence available in a concise format. Emergency departments (EDs) are an ideal site for guidelines given the wide variety of presenting conditions and treating providers, and the need for timely decision making. We designed a programme for guideline development and implementation and evaluated its impact in an ED.
The setting was an urban paediatric ED with an annual volume of 60 000. Common and/or high-risk conditions were identified for guideline development. Following implementation of the guidelines, their impact on effectiveness of care, patient outcomes, efficiency and equitability of care was assessed using a web-based provider survey and performance on identified metrics. Variation in clinical care between providers was assessed using funnel plots.
Eleven (11) guidelines were developed and implemented. 3 years after the initiation of the programme, self-reported adherence to recommendations was high (95% for physicians and 89% for nurses). 97% of physicians and 92% of nurses stated that the programme improved the quality of care in the ED. For some guidelines, provider-to-provider care practice variation was reduced significantly. We found reduced disparity in imaging when assessing one guideline. There were also reductions in utilisation of diagnostic tests or therapies. As a balancing measure, the percentage of patients with any of the guideline conditions who returned to the ED within 72 h of discharge did not change from before to after guideline initiation. Overall, 80% of physician and 56% of nurse respondents rated the guideline programme at the highest value.
A programme for guideline development and implementation helped to improve efficiency, and standardise and eliminate disparities in emergency care without jeopardising patient outcomes.