Quality of brief guidelines produced by professional bodies: a study of the 'green-top' guidelines by the UK Royal College of Obstetricians and Gynaecologists

Abstract

Clinicians ignore lengthy guidelines and prefer pocket cards and concise pamphlets. However, brevity in guidelines may lead to deficiency in quality. Our objective, therefore, was to examine the quality of brief guidelines produced by professional bodies, using those produced by the UK Royal College of Obstetricians and Gynaecologists (RCOG) as an example. We assessed all 22 'green-top' guidelines, produced by September 2002, for quality using a validated 37-item appraisal instrument. This instrument evaluated the guidelines on three dimensions, namely rigour of development, context and content and applicability. Ten (45%), 18 (82%) and five (23%) of the 22 guidelines met at least half the quality criteria for rigour of development, context and content and applicability, respectively. We conclude that the brief guidelines were deficient in several specific quality items, particularly those in the applicability dimension. Guideline developers need to achieve the higher quality standards expected of professional bodies.

Guidelines for the management of pelvic pain associated with endometriosis: a systematic appraisal of their quality

“…The use of both appraisal instruments allowed a comparison of our data with a wide range of other published guideline reviews (see below). 3,[17][18][19][20]22,23 Although the methodological quality of current endometriosis guidelines was low, the clinical advice contained in these documents was similar, although it was not always supported by evidence possibly due to lack of quality primary research in this field. Only three of eight guidelines met at least half of the quality standards in the rigour of development domain, with low scores attributable to a lack of external expert review, details of future updates and that risks have been considered in formulation of the recommendations.…”

“…They need to be free of biases, which could not only result in the denial of best care but also lead to harmful practices. 2 Attempts to evaluate the quality of guidelines have generally shown poor adherence to the quality standards 3,[17][18][19][20] (Tables 4 and 5). This is of particular concern for guidelines produced by professional bodies as they reach a targeted audience that is generally expected to accept the recommendations as 'the standard to be achieved'.…”

Acute complete uterine inversion after controlled cord traction of placenta following vaginal delivery: a case report

“…In a guideline published by the Royal College of Obstetricians and Gynaecologists (Green‐top Guidelines No. 52), there are four components in the management of PPH, in the order of: Communication, Resuscitation, Monitoring and Investigation, and Arresting the bleed.…”

“…The guidelines suggested that once the uterus was successfully inverted and other causes of PPH were ruled out, pharmacological and mechanical interventions should be initiated. This involved bimanual compression and injection of syntocinon, ergometrine or carboprost . Misoprostol can also occasionally be given per rectal .…”

Guidelines: a love–hate relationship?

“…As such, guidelines are not perfect; they can be extremely long and consequently may not be used, and the quality, context and applicability are sometimes criticised. [3][4][5][6] It is this area that causes contention, creates questions and suggests the need for thought. What do you do if you disagree with a guideline recommendation or approach?…”