Availability and development of guidelines in a tertiary teaching hospital

The purpose of this study was to review existing guidelines in clinical departments and describe their characteristics, development and implementation at a large teaching hospital in Sydney, Australia.

The study was undertaken in two stages. First, from September to November 2005, we reviewed and classified documents from eight departments as clinical practice guidelines (CPGs), clinical procedural protocols (technology and technique) or administrative guidelines. We also collected information about the scope, format and target user of the guidelines. Second, from March to June 2006, we interviewed department staff in seven of eight participating departments about the guidelines' development and implementation. A revised Appraisal of Guidelines Research and Evaluation questionnaire was used to collect data in both stages.

A total of 368 of 509 documents reviewed were classified as CPGs. Almost 90% of the CPGs had five or fewer pages; nearly 80% had no references; and 90% had no application tools. The CPGs had been developed locally by each individual department. The departments used various methods to collect evidence. In six (albeit a different six departments in each case) of seven departments, clinicians' clinical experience was used in the analysis of the evidence; informal expert consensus was used for formulating recommendations; internal peer review was the major method used to review the guidelines (after drafting); hard copy of guidelines was the major medium used; and provision of educational material was the major implementation strategy.

There was great variation in the number, availability and presentation of guidelines in the departments. There was a lack of standardized methods and narrow skills representation during guideline development.