Article

Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal

Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni M Claret 171, 08041 Barcelona, Spain.
Quality and Safety in Health Care (Impact Factor: 2.16). 12/2010; 19(6):e50. DOI: 10.1136/qshc.2009.038653
Source: PubMed

ABSTRACT Surgical care is an important burden in healthcare, and the complications and harm related to surgery are of special concern. Clinical practice guidelines in perioperative care should provide the opportunity to minimise these risks and improve surgical outcomes, but their quality has not yet been evaluated systematically.
To evaluate the quality of clinical practice guidelines (CPGs) for the prevention of perioperative adverse events.
A systematic search of scientific literature published between 1990 and 2008 was undertaken to identify and select CPGs related to the treatment of surgical patients, particularly those seeking to prevent surgical adverse events. The authors searched the main guideline databases and guideline developer websites, and completed the search in MEDLINE. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Their degree of agreement was evaluated with the intraclass correlation coefficient (ICC).
Twenty-two CPGs were chosen for evaluation from a total of 6181 references. The overall agreement among reviewers was moderate (ICC: 0.68; 95% CI 0.46 to 0.84). The scores for each of the AGREE domains were: scope and purpose 80.9% (range: 40.7-100%); stakeholder involvement 51.3% (range: 8.3-88.8%); rigour of development 61.2% (range: 26.9-96.8%); clarity and presentation 69.7% (range: 33.3-94.4%); applicability 42.5% (range: 7.4-92.5%); and editorial independence 57% (range: 27.7-100%). Most of the appraised guidelines could be recommended (n = 10) or recommended with provisos (n = 10) for use in clinical practice. Guidelines developed by research agencies or guideline developers were of a higher quality than those developed by scientific societies. The authors did not detect any improvement over time in guideline quality.
The quality of guidelines for perioperative care is moderate. Measures should be taken to guarantee that CPGs are based on the best available evidence and rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision-making in this field.

0 Followers
 · 
179 Views
  • Canadian journal of surgery. Journal canadien de chirurgie 10/2013; Accepted for publication. DOI:10.1503/cjs.029612 · 1.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: This study demonstrates the development, reliability and outcome of a targeted method for standardized assessment of adverse drug events (ADEs) in surgical patients. METHODS: Initial practice evaluation of this ADE assessment method was carried out in a prospective single centre cohort study. In total, 262 electively admitted surgical patients were included. The surgical trigger tool was applied to patients' medical records by two independent reviewers, and subsequent assessment of causality, severity and preventability of ADEs was carried out by two independent expert panels consisting of a consultant surgeon and a clinical pharmacologist. The surgical trigger tool and causality assessment method were each tested on reliability in a separate group of 50 randomly selected patients using Fleiss and Cohen's kappa statistics and percentages of agreement. Comparison of this method with an existing trigger tool method for ADEs was performed. RESULTS: Our surgical trigger tool contains 51 triggers. The inter- and intra-rater calculations showed substantial to almost perfect levels of agreement (kappa range 0.71-0.83), with a 97.8-98.5% percentage of agreement. Fair to substantial levels of agreement were calculated for causality, severity and preventability (kappa range 0.38-0.79). The percentages of inter- and intra-rater agreement were 68.9 and 70.5% for causality, 67.0 and 82.0% for severity, and both 98.4% for preventability, respectively. Compared with the existing trigger tool method for ADEs, we found an additional 363 triggers, 18 ADEs (an extra 20%) and 3 preventable ADEs in our surgical cohort. CONCLUSIONS: This targeted trigger tool for standardized assessment of ADEs in surgical patients shows excellent agreement between reviewers. The assessment of medication-related harm had acceptable agreement. Compared with an existing ADE trigger tool method, the present method found almost 20% extra ADEs. This method can be a useful alternative to existing trigger tool methods, in particular to assess medication safety in surgical patients.
    Journal of Evaluation in Clinical Practice 04/2013; 19(6). DOI:10.1111/jep.12033 · 1.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention. Aim To overview of current national European guidelines for C. difficile infection (CDI) prevention and reviews the recommendations in respect of their evidence base and conformity to each other and the European Centre for Disease Control and Prevention (ECDC) guidance. Methods In 34 European countries, the ECDC healthcare-associated infection (HCAI) surveillance National Contact Points and other HCAI experts (NCPs) were invited to complete an online questionnaire and to supply their guidelines. Guidelines not available in English, French or German were translated into English. For the qualitative analysis, a matrix with key measures based on the 2008 ECDC guidance was established. The review process was conducted independently by two reviewers. Results All 34 NCPs responded to the questionnaire and supplied 15 guidelines in total. Six of 34 (18%) countries reported having used the ECDC guidance as a basis for the development or revision of their national guideline. There was wide variation in the scope and detailing. Only six of the documents and the ECDC guidance supplied a rating for the strength of recommendations. The rating systems varied in how the categories were defined. Furthermore, the stated strength for similar measures varied across different guidelines. Conclusion The ECDC guidance has not yet had a strong influence on the development or revision of national CDI prevention guidelines. One possible explanation for the variations is the necessity to adapt recommendations to national conditions. The use of internationally recognized instruments for the development of guidelines could help to improve their quality. Recommendations about monitoring or auditing the implementation would make them more useful.
    Journal of Hospital Infection 08/2014; 87(4). DOI:10.1016/j.jhin.2014.05.002 · 2.78 Impact Factor

Full-text

Download
101 Downloads
Available from
May 31, 2014