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Introducing guidelines into clinical practice.

F G Fowkes, C J Roberts

    Effective Health Care
    |March 11, 1984
    PubMed
    Summary
    This summary is machine-generated.

    Clinical practice guidelines are essential due to finite healthcare resources. A UK study found pre-operative chest X-rays varied widely and lacked proven effectiveness, prompting guideline development.

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    Area of Science:

    • Health Policy
    • Clinical Practice Guidelines
    • Radiology Utilization

    Background:

    • Healthcare systems face increasing pressure from finite resources and demand for equitable care.
    • Traditional clinical practice often involved ordering numerous diagnostic tests without strict cost-benefit analysis.
    • Clinical practice must balance safety, efficacy, and socially acceptable costs.

    Purpose of the Study:

    • To address the need for evidence-based clinical practice guidelines in healthcare.
    • To investigate the utilization and effectiveness of pre-operative chest X-rays in the UK.
    • To inform the development of guidelines for appropriate diagnostic test usage.

    Main Methods:

    • A multicentre review of 10,619 elective non-cardiopulmonary surgery cases across 8 UK centres in 1979.

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  • Analysis of variations in the use of pre-operative chest X-rays.
  • Evaluation of the impact of chest X-ray reports on surgical and anaesthetic decisions.

    • Main Results:

    • Significant variations in pre-operative chest X-ray utilization, ranging from 11.5% to 54.2% between centres.
    • Chest X-ray reports had minimal influence on decisions regarding surgery or inhalation anaesthesia.
    • No evidence found for the routine effectiveness of pre-operative chest X-rays; estimated cost to prevent one death was £1 million.

    Conclusions:

    • The findings demonstrated a lack of evidence supporting routine pre-operative chest X-rays, highlighting the need for clinical guidelines.
    • Guidelines are crucial for optimizing resource allocation and ensuring cost-effective, safe patient care.
    • A three-stage process (introduction, implementation, sustained use) is proposed for guideline adoption in clinical practice.