Notice to comply: A systematic review of clinician compliance with guidelines surrounding acute hospital-based infection management - 25/07/20
, Maria E. Mayorga, PhD b, Kristen E. Miller, MSPH, DrPH c, Nishant Singh, BS b, Ryan C. Arnold, MD d, Santiago Romero-Brufau, MD e, fHighlights |
• | Guideline design and implementation vary in studies reporting clinician compliance. |
• | We systematically reviewed articles reporting compliance with infection guidelines. |
• | We characterized compliance results and compared intervention strategies for trends. |
• | Multimodal interventions seem to produce the greatest improvement in compliance. |
• | Future research connecting guideline design to relevant patient outcomes is merited. |
Résumé |
Purpose |
To identify and characterize studies evaluating clinician compliance with infection-related guidelines, and to explore trends in guideline design and implementation strategies.
Data sources |
PubMed database, April 2017. Followed the PRISMA Statement for systematic reviews.
Study selection |
Scope was limited to studies reporting compliance with guidelines pertaining to the prevention, detection, and/or treatment of acute hospital-based infections. Initial search (1,499 titles) was reduced to 49 selected articles.
Data extraction |
Extracted publication and guideline characteristics, outcome measures reported, and any results related to clinician compliance. Primary summary measures were frequencies and distributions of characteristics. Interventions that led to improved compliance results were analyzed to identify trends in guideline design and implementation.
Results of data synthesis |
Of the 49 selected studies, 18 (37%), 13 (27%), and 10 (20%) focused on sepsis, pneumonia, and general infection, respectively. Six (12%), 17 (35%), and 26 (53%) studies assessed local, national, and international guidelines, respectively. Twenty studies (41%) reported 1-instance compliance results, 28 studies (57%) reported 2-instance compliance results (either before-and-after studies or control group studies), and 1 study (2%) described compliance qualitatively. Average absolute change in compliance for minimal, decision support, and multimodal interventions was 10%, 14%, and 25%, respectively. Twelve studies (24%) reported no patient outcome alongside compliance.
Conclusions |
Multimodal interventions and quality improvement initiatives seem to produce the greatest improvement in compliance, but trends in other factors were inconsistent. Additional research is required to investigate these relationships and understand the implications behind various approaches to guideline design, communication, and implementation, in addition to effectiveness of protocol impact on relevant patient outcomes.
Le texte complet de cet article est disponible en PDF.Key Words : Guideline adherence, Practice patterns (physicians), Quality, Program evaluation, Professional practice gaps, Outcome and process assessment (health care)
Plan
| Conflicts of interest: None to report. |
|
| Funding: This work was supported by the National Science Foundation (IIS1522072, IIS1522106, IIS1522107, IIS1833538). |
Vol 48 - N° 8
P. 940-947 - août 2020 Retour au numéro
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