Factors influencing long-term adherence to two previously implemented hospital guidelines.

Int J Qual Health Care. 2010 Oct;22(5):421-9

Authors: Knops AM, Storm-Versloot MN, Mank AP, Ubbink DT, Vermeulen H, Bossuyt PM, Goossens A

OBJECTIVE AND SETTING: After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. DESIGN AND PARTICIPANTS: A fluid balance guideline (FBG) and body temperature guideline (BTG) were developed and implemented in our hospital in 2000. Long-term adherence was determined retrospectively based on data from patient files. Focus groups were launched to explore nurses’ perceptions of barriers and facilitators regarding long-term adherence. The predominant themes from the nurses’ focus groups were posed to clinicians in questionnaires. RESULTS: Nurses involved in the FBG (overall adherence 100%) stated that adherence has immediate advantages in terms of safety and a gain in time. Nurses and oncologists acted unanimously which was thought to enhance adherence. On the other hand, opinions differed on the BTG within the nursing teams and medical staff (overall adherence 50%). Although the guideline discourages routine postoperative body temperature measurements, temperature should be measured according to the guideline in a considerable number of cases due to changes in patient characteristics since the year 2000. Therefore, adherence was judged to be rather complex. CONCLUSIONS: To secure adherence to hospital guidelines after their successful implementation, guidelines should preferably be comprehensive in terms of being applicable to the majority of the patients in that particular setting and to the most common clinical situations. All healthcare professionals involved should be aware of its immediate benefits for themselves or to their patients.

PMID: 20716551 [PubMed - in process]

Implementation of a shared care guideline for back pain: effect on unnecessary referrals.

Int J Qual Health Care. 2010 Oct;22(5):415-20

Authors: Fleuren M, Dusseldorp E, van den Bergh S, Vlek H, Wildschut J, van den Akker E, Wijkel D

OBJECTIVE: To determine the effect of the implementation of a shared care guideline for the lumbosacral radicular syndrome (LRS) on unnecessary early referrals and the duration of the total diagnostic procedure. DESIGN: Introduction of shared care guideline in November 2005. Pre-test in 2005 (April to October), a first post-test in 2006 (April to October) and a second post-test in 2007 (April to October). SETTING: and INTERVENTION: The introduction of a shared care guideline derived from national guidelines for GPs and several medical/paramedical specialists in two Dutch regions. Three hundred and sixty GPs, 550 physiotherapists and two hospitals (9 neurologists and 18 radiologists) were involved. The essential component of the guideline was a trade-off: if the GP complied with the conservative management approach in the first 6 weeks, the hospital guaranteed a priority appointment with the neurologist after 6 weeks, if still required. MAIN OUTCOME MEASURES: The neurologists in both hospitals registered whether a patient had been unnecessarily referred during the first 6 weeks. The duration of the total diagnostic procedure was defined as the number of days between referral by the GP and the consultation when the neurologist made the final diagnosis. RESULTS: The percentage of patients being unnecessarily referred within 6 weeks fell significantly from 15% in 2005 to 9% in 2006 and 8% in 2007. The duration of the total diagnostic procedure also fell significantly in both the long and short terms. CONCLUSIONS: The introduction of a shared care guideline for all care providers in a region reduces the number of unnecessary early referrals for patients with LRS.

PMID: 20705753 [PubMed - in process]