Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review

Abstract

A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals’ adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was <10 years. Finally, articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals’ adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the emergency care settings is minimal, future research should identify such factors to allow the development of strategies to improve adherence and thus improve quality of care.

Meta-analysis of pain and stress in emergency department patients

“…This makes it difficult to access help for people who need immediate medical intervention. For each patient, taken to an emergency department, in accordance with current guidelines, it is decided whether the patient requires emergency diagnostics, hospitalization and surgery on an ad hoc basis or supply within the emergency department of further diagnosis and therapy [2][3][4].…”

Atributos de las guías clínicas del régimen de garantías en salud relacionados con su adopción en la atención primaria: una evaluación en 3 centros de salud familiar

“…Estos niveles de adherencia y su variabilidad no son diferentes de lo publicado internacionalmente respecto de la adherencia a recomendaciones en distintas áreas clínicas 19,20 . Esta similitud con otros estudios sumada a la concordancia satisfactoria en la auditoria "doble" realizada a una submuestra de los registros apoya la confiabilidad en las mediciones de adherencia realizadas en el estudio.…”

North Carolina College of Emergency Physicians' Guidance Document on Emergency Medical Services

“…Requiring all EMS providers in North Carolina to follow the protocols, procedures, policies, and other relevant sections in the NCCEP document ensures a minimum baseline level of care and helps standardize prehospital care throughout the state. It has been shown that standardizing patient care reduces variation in clinical practice [2][3][4]. This is particularly important in North Carolina because many providers work in multiple EMS agencies throughout the state [5].…”

“…Protocolized patient care has been shown to lead to better patient outcomes [3,4,10,11]. As such, the EMS Protocols section of the NCCEP document is perhaps the most important part of the document, and it contains 102 protocols.…”