A Checklist-based guideline system - For implementing clinical guidelines into practice

Abstract

Mængden af kliniske viden vokser fortsat, med stigende fokus på forskning. I daglig praksis er evidensbaserede kliniske retningslinjer begyndt at spille en større rolle, hvor kliniske retningslinjer har i mange år bidraget til at både forbedre kvaliteten af patient-pleje og -sikkerhed. Imidlertid har implementering af retningslinier vist begrænset succes, og metoder for implementering varierer meget i mellem regionerne, som resulterer også i en høj variation i kvaliteten af behandling. I de senere år har kliniske-tjeklister påkaldt sig særlig opmærksomhed, da deres anvendelse i klinisk-praksis har vist lovende resultater, for at sikre overholdelse af klinisk-retningslinjer. Dog er der stadig mangel på sammenhæng mellem de tjeklister, der anvendes, og den kliniske-viden, de skal overholde. Det er klart, at hvis evidensbaseret behandling skal fortsætte med at være standard i det fremtidige tilstand af klinisk-praksis, skal implementeringsprocessen af retningslinjer gøres mere strømlinet; gerne med brug af et it-baseret løsning. Projektets problemstilling blev derfor at identificere krav, som kunne muliggøre udvikling af et klinisk-informationssystem, som overvinder de udfordringer med, implementering og overholdelse af kliniske retningslinjer, i praksis. Et proof of concept, kaldet CliniCheck, blev udviklet og implementeret som et web-applikation, der eksemplificerer, hvordan retningslinjer og tjeklister kan implementeres og anvendes under et operativt-forløb på et sygehus. CliniCheck opfyldte de identificerede krav, samtidig med at tage hensyn til de syv karakteristika, der beskrives af Garde and Knaup [2006]. Selvom CliniCheck har kun eksemplificeret hvordan kravene kan blive opfyldt indenfor et operativt-forløb, vil modellen stadig illustrere, hvordan et tjekliste-baseret retningslinjesystem kunne fungere i praksis. Dog hvis kravene skal kunne anvendes til at udvikle et system, kræver det mere omfattende evaluering og design-input fra selve slutbrugerne.

Clinical knowledge is ever growing and evidence based clinical guidelines have started to play an increasingly bigger role in today's standardized care. For many years, guidelines have helped to both improve the quality of patient-care and -safety. However, implementation of guidelines has shown limited success, and methods of implementation do highly vary between regions, which results in high variation in quality of treatment as well. In recent years, clinical checklists have been gaining more attention, as their use in clinical practice, to help ensure compliance with clinical guidelines, has shown promising results. Nevertheless, there is still lack of coherence between the checklists being used and the clinical-knowledge they are complying with. It is clear that if guidelines are to comply with the future state of healthcare their use in a clinical setting needs to be reconsidered, preferably with the use of an IT based solution. The project's objective was therefore set on defining, and evaluating, requirements which could enable prediction of such a clinical-information-system. A proof of concept, called CliniCheck, was developed and implemented into a functioning web-application, which exemplifies how guidelines and checklists can be implemented and used within a surgery pathway in a hospital setting. CliniCheck served to fulfill the requirements identified, while also taking into account the seven characteristics of healthcare described by Garde and Knaup [2006]. Although CliniCheck serves to only exemplify the requirements within a surgery pathway, the model still manages to illustrate how a checklist-based guideline systems could function in practice. Nevertheless, if the requirements are to be used for predicting a clinical guideline system, more extensive evaluation and design-input is needed from its end-users.

A master thesis from Aalborg University

A Checklist-based guideline system - For implementing clinical guidelines into practice

[Tjeklist-baseret retningslinje-system - For at implementere kliniske retningslinjer i praksis]