Developing clinical standards: One model
Developing clinical standards: One model
Clinical standards in EMSC
Because unwanted variation can exist anywhere in the continuum, a gap in quality can have the net effect of less than optimal outcomes for the child. Aligning care with clinical standards supported by systematic approaches to guideline development will improve the probability that patient populations will receive care based on the most current professional knowledge. Clinical guidelines serve to synthesize available evidence and bridge the gap between science and clinical practice; not through rigid protocol adherence but by a framework for care delivery, thus contributing to efficiency, cost containment, and improved patient outcomes.11 Clinical standards may refer to pathways, protocols, evidence-based summaries, or full guidelines, and ideally are developed in a patient-/family- centric manner in order to address care across the continuum.
National attention for the need for evidence-based clinical standards for prehospital care has been growing despite the limited research on the direct benefits of existing prehospital evidence-based guidelines (EBGs), mostly because of the wealth of evidence to illustrate their contributions to improved outcomes in other medical fields and other EMSC settings.12-14 One pediatric study used improvement science methodology to improve adherence to national septic shock guidelines, consequently demonstrating improvement in process and outcome measures.15 A study of over 180,000 children with gastroenteritis found that hospitals adhering to published guidelines had 50% lower charges for ED or observation patients without adverse effects on other outcomes.16 Guidelines for diagnosis and management of bronchiolitis both in the ED and across the hospital continuum have been associated with improved outcomes through decreases in utilization of unnecessary testing and interventions, including decreases in costs.17-21
Several organizations and systems have developed strategies for minimizing unwanted variation in clinical care by utilizing systematic approaches to development of evidence-based clinical standards. Concurrently, they have described improved processes and outcomes, many of which include reduced costs.4,22-24 Thus, there is a plethora of experiential learning from clinical standards work that is applicable to the EMSC environment.
Developing clinical standards: One model
At Texas Children’s Hospital/Baylor College of Med of clinical standards. The core elements of systematic clinical standards development are described below and are applicable to any venue of care.
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