Methods used by guideline developers to create out-of-hospital health guidelines: a cross-sectional survey

Health guidelines are commonly used by clinicians that practice in the out-of-hospital setting (paramedics, emergency medical technicians, and first responders) to inform clinical decision-making. The specific development techniques used to generate these documents however is currently unclear. To address this, we conducted an anonymous online cross-sectional survey of developers of out-of-hospital health guidelines to determine how current practices compare with guidance contained within the Guidelines International Network (GIN)-McMaster Guideline Development Checklist (GDC).

This survey was comprised of binary and open-ended questions that were based upon the 18 topics and 146 steps contained within the GIN-McMaster GDC. Following data collection, we performed a qualitative content analysis which involved grouping responses into categories based on the observed similarities and differences.

A total of 104 developers of out-of-hospital guidelines completed the survey, with 34% (35/104) reporting familiarity with the GIN-McMaster GDC and 8% (8/104) having used this resource during guideline development. Overall, 61% (63/104) of the respondents reported developing guidelines de novo, while 48% (50/104) and 40% (42/104) had used adaptation and adoption techniques. When developing recommendations, most respondents reported using standardized wording (78/104, 75%), including the certainty of evidence (61/104, 59%), and the strength of the recommendation (60/104, 58%). Conversely, only a small proportion of respondents reported monitoring how recommendations were applied in practice (46/104, 44%), creating performance measures or quality indicators (34/104, 33%), and pilot testing with end-users prior to implementation (25/104, 24%).

In this cross-sectional survey, we describe how the current practices of developers of out-of-hospital health guidelines align with the GIN-McMaster GDC. This information will be used to inform the development of a contextualized extension of this checklist to strengthen guideline development processes in this field.