Comparative Case Study Analysis of Five Clinical Practice Guidelines in Anesthesiology
Working Paper 68
Clinical practice guidelines (CPG) are evidence-based recommendations that influence clinical practice, with a goal of reducing patient harm and improving patient outcomes. Yet the uptake of CPGs in clinical practice may vary to due contextual factors. We conducted a cross-case analysis of five CPGs to (1) identify whether these previously published anesthesia practice guidelines changed clinical practice; (2) assess the evidence base for previously published anesthesia practice guidelines; and (3) identify the facilitators and barriers to guideline implementation. We synthesized evidence across three sources: (1) the guideline document, (2) published information in peer-reviewed literature, and (3) interviews with nine anesthesiologists. We found that when consistent evidence supported guideline recommendations, clinical practice change occurred, and clinicians adopted new guidelines. Clinicians reported that most guidelines had recommendations that were broad or lacked clarity, which were both barriers to guideline use. Weak or insufficient evidence support vague guideline recommendations. Clinician held positive beliefs about guidelines. They agreed with the guidelines and believed they improved care (4 guidelines), and thought the guidelines were feasible and helpful (3 guidelines). Finally, we found that organizational characteristics can facilitate practice change and promote CPG use. The results from this study demonstrate that multiple barriers and facilitators at the clinician, organization, and system levels can affect practice change and guideline use. Understanding the barriers and facilitators to practice change and CPG use is critical to improving patient care. In anesthesiology, important factors for practice change and guideline use might include the consistency of the evidence supporting the guideline and the organizational supports in place to encourage its use. More research is needed to further understand how clinicians who provide team-based care translate guidelines to practice, and the barriers and facilitators to guideline use in that setting.