Developing evidence-based practice guidelines and pathways: the experience at the local hospital level

Using an evidence-based approach to developing clinical practice guidelines at the local level promotes implementation by clinicians. In 1994 Cedars-Sinai Health System embarked on a joint project with VHA, Inc, to pilot test a software program, Clinical Cost-Reduction System (CCRS), featuring length-of-stay guidelines for low-risk patients with specific conditions. Data currently are being collected on the effect of the software on length-of-stay reductions and other important patient outcomes.

To involve clinicians more actively in the development of guidelines, Cedars-Sinai sought to develop a software system for presenting organized medical information to hospitals interested in designing their own evidence-based clinical pathways.

The CPC is a computerized grid for writing clinical pathways, backed by a database of information for select clinical conditions and categories of care. Multidisciplinary teams are to review the evidence presented in the database and then determine those guidelines they wish to encode into an actual pathway, which can then be printed out. The decision regarding which guidelines to use and which not to use rests entirely with the team designing a pathway; the program is intended to aid the team in developing appropriate guidelines that are evidence based, not to legislate guidelines. Data on the "portability" of the program are still being collected.

There are many challenges involved in searching, summarizing, and classifying the medical literature.