When guidelines guide us to harm

Brichko, Lisa; Mitra, Biswadev; Cameron, Peter

doi:10.1111/1742-6723.13189

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Investigations, antibiotics, and admissions are associated with iatrogenic complications, adverse events, hospital acquired infections, increased costs for the healthcare system, and financial burden and stress for the families ( 13 , 35 – 38 ). Hence, guidelines by increasing investigations, antibiotics, and admissions can result in “patient harm.” Such concerns that guidelines might result in more harm than benefit for the patient and that the best way to prevent patient harm might be by doing less, have already been raised in the literature ( 39 – 41 ). If physicians had followed the guideline in the study PEDs, febrile infants would have been exposed to 2- to 4-fold more LPs, antibiotic treatments, and hospitalizations without identifying any case of meningitis or bacteremia.…”

Section: Discussionmentioning

confidence: 99%

“…In infants aged 22-59 days, urine cultures increased from 38% (95% CI, 34-43) to 65% (95% CI, 61-69), whereas the number of lumbar punctures and blood cultures did not change. The number of hospitalizations decreased from 47% (95% CI, 43-51) to 35% (95% CI, [30][31][32][33][34][35][36][37][38][39]. The use of PCT increased from 8% (95% CI, 5-10) to 62% (95% CI, 58-66) (Table 2).…”

Section: Differences In Management Of Infants Aged 22-59 Days With Fwsmentioning

confidence: 99%

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Low adherence to a new guideline for managing febrile infants ≤59 days

Elliver,

Norrman,

Orfanos

2024

Front. Pediatr.

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BackgroundManagement of young febrile infants is challenging. Therefore, several guidelines have been developed over the last decades. However, knowledge regarding the impact of introducing guidelines for febrile infants is limited. We assessed the impact of and adherence to a novel guideline for managing febrile infants aged ≤59 days.MethodsThis retrospective cross-sectional study was conducted in 2 pediatric emergency departments in Sweden between 2014 and 2021. We compared the management of infants aged ≤59 days with fever without a source (FWS) and the diagnosis of serious bacterial infections (SBIs) before and after implementing the new guideline.ResultsWe included 1,326 infants aged ≤59 days with FWS. Among infants aged ≤21 days, urine cultures increased from 49% to 67% (p = 0.001), blood cultures from 43% to 63% (p < 0.001), lumbar punctures from 16% to 33% (p = 0.003), and antibiotics from 38% to 57% (p = 0.002). Only 39 of 142 (28%) infants aged ≤21 days received recommended management. The SBI prevalence was 16.7% (95% CI, 11.0–23.8) and 17.6% (95% CI, 11.7–24.9) before and after the implementation, respectively. Among infants aged ≤59 days, there were 3 infants (0.6%; 95% CI, 0.1–1.7) in the pre-implementation period and 3 infants (0.6%; 95% CI, 0.1–1.7) in the post-implementation period with delayed treated urinary tract infections.ConclusionsInvestigations and antibiotics increased significantly after implementation of the new guideline. However, doing more did not improve the diagnosis of SBIs. Thus, the low adherence to the new guideline may be considered justified. Future research should consider strategies to safely minimize interventions when managing infants with FWS.

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Section: Discussionmentioning

confidence: 99%

Section: Differences In Management Of Infants Aged 22-59 Days With Fwsmentioning

confidence: 99%

Low adherence to a new guideline for managing febrile infants ≤59 days

Elliver,

Norrman,

Orfanos

2024

Front. Pediatr.

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“…Clinical practice guidelines may have limitations in their applicability to local contexts [ 46 ] and sometimes lead to overmedicalization [ 47 ]. Interviewees expressed that doctors should not mindlessly adhere to the treatment or examination protocols outlined in clinical practice guidelines, advocating for individualized care tailored to specific circumstances; however, if healthcare professionals have not attached to the guidelines and execute the most comprehensive treatment and examination protocols, they may face responsibility and risks, potentially leading to medical disputes that feel just like “walking on eggshells.“(P07, P08, P09):…”

Section: Methodsmentioning

confidence: 99%

“I feel like I’m walking on eggshells”: a qualitative study of moral distress among Chinese emergency doctors

Liu,

Dai,

Song

et al. 2024

BMC Med Ethics

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Background While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources. Aim This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it. Method Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi’s phenomenological analysis method. Study findings This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress. Conclusion The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors’ communication skills.

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“…Third, insu cient investment in the CPG industry may also lead to unintended consequences related to using low-quality clinical guidelines not updated according to the most recent and high-quality evidencebased medicine or health technology assessment, which may lead to patients being prevented from receiving the most effective treatments available in the market or sometimes being over treated, which will in turn affect patients' health outcomes and the cost of care (2,(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the impact of investing in the industry of clinical practice guidelines for health systems

Hassanien

2021

Preprint

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Rationale: This research has been conducted to facilitate evidence-informed policymaking and to help health-care policymakers in Saudi Arabia to decide whether or not a sustainable investment in the CPG industry is socially and economically viable. Objectives: The objective is to investigate: (i) whether the clinical practice guidelines help to improve clinical practice and save costs, and (ii) the views in Saudi Arabia about implementing clinical practice guidelines. Methods: The study employs mixed methods, including: (i) a literature review to evaluate the benefits of implementing clinical practice guidelines, and (ii) an online survey to investigate views about implementing the guidelines' benefits. Results: (i) The clinical practice guidelines do help in improving clinical practice, but the evidence about their impact on saving costs is insufficient in the literature. (ii) The survey demonstrated a high level of awareness among health system actors in Saudi Arabia of the importance of having nationally unified clinical guidelines. Recommendations: Investment in the clinical practice guidelines industry seems socially and economically viable.

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When guidelines guide us to harm

Cited by 5 publications

References 17 publications

Low adherence to a new guideline for managing febrile infants ≤59 days

Low adherence to a new guideline for managing febrile infants ≤59 days

“I feel like I’m walking on eggshells”: a qualitative study of moral distress among Chinese emergency doctors

Evaluating the impact of investing in the industry of clinical practice guidelines for health systems

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