A medical guideline (also called a clinical
guideline, clinical protocol or clinical practice guideline)
is a document with the aim of guiding decisions and criteria
in specific areas of healthcare, as defined by an authoritative
examination of current evidence (evidence-based medicine). Guidelines
usually include summarized consensus statements, but unlike
the latter, they also address practical issues.
Clinical guidelines briefly identify, summarize
and evaluate the best evidence and most current data about prevention,
diagnosis, prognosis, therapy, risk/benefit and cost/effectiveness.
Then they define the most important questions related to clinical
practice and identify all possible decision options and their
outcomes. Thus, they integrate the identified decision points
and respective courses of action to the clinical judgment and
experience of practitioners.
Additional objectives of clinical guidelines
are to standardize medical care, to raise quality of care, to
reduce several kinds of risk (to the patient, to the healthcare
provider, to medical insurers and health plans) and to achieve
the best balance between cost and medical parameters such as
effectiveness, specificity, sensitivity, resolutiveness, etc.
The guideline-based approach to healthcare
is a relatively recent one and has originated in the United
States in the 90s. Guidelines are usually produced at national
or international levels by medical associations or governmental
bodies, such as the US Agency for Healthcare Research and Quality.
Local healthcare providers may produce their own set of guidelines
or adapt them from existing top-level guidelines. It has been
demonstrated repeatedly that the use of guidelines by healthcare
providers such as hospitals is an effective way of achieving
the objectives listed above, although they are not the only
Special computer software packages have been
developed to facilitate the production and use of medical guidelines.
On-line medical literature databases (such as PubMed) and evidence-based
medicine databases (such as the Cochrane Collaboration), and
printed and electronic publications exist in large numbers for
this purpose. The USA and other countries maintain medical guideline
clearinghouses. Clinical guidelines may include or not decision
or calculation algorithms.
It has been found that some simple clinical
practice guidelines are not routinely followed to the extent
they might be. It has been found that providing a nurse or other
medical assistant with a checklist of recommended procedures
can result in the attending physician being reminded in a timely
manner regarding procedures that might have been overlooked.
In the USA, the National Guideline Clearinghouse
produces guidelines. In the United Kingdom, this task is performed
by the National Institute for Clinical Excellence (NICE). In
The Netherlands, two bodies (CBO and NHG) publish specialist
and primary care guidelines, respectively.