Clinical Guidelines: Moving from Recommendations to Action
Anne L. Coleman, MD, PhD, Director, Hoskins Center for Quality Eye Care, remarked that various studies have evaluated the reasons that lead to medical errors. Investigations in a Veterans Administration (VA) study from 2001 to 2006 found that communication problems were responsible for medical errors in 21% of cases. An extension of the study from 2006 to 2009 found that a lack of standardization of clinical processes and failure to follow clinical guidelines jeopardized patient safety.
Clinical guidelines are systematically developed statements based on evidence to assist the practitioner in making decisions about patient care, and such guidelines can improve the quality of eye care for patients. The Academy has created a set of evidence-based clinical guidelines, called Preferred Practice Pattern® (PPP) guidelines. Fully implementing these may be challenging and take several decades.
To move from clinical guidelines to action, the introduction of alerts or reminders in EHRs may help, for example, in the form of pop-up boxes to indicate that the patient has diabetes and needs a dilated exam. Data collected from the IRIS Registry may be useful in developing a higher level of evidence-based guidelines to replace many of the current consensus-based recommendations. Practitioners may then be more likely to incorporate the guideline recommendations into their clinical practice because the recommendations may be more clinically relevant and reflective of their own practice.
Several years ago, the Academy conducted a performance-improvement activity called the Wrong-Site/Wrong-IOL Surgery in a continuing medical education course developed by the faculty at University of California, Los Angeles (UCLA). It is currently on the Academy’s Ophthalmic News and Education (ONE®) Network and is required at UCLA for ophthalmologists who perform an injection on the wrong eye or implant the wrong IOL. The course is designed to improve awareness and prevent operating theater mistakes related to wrong site, wrong patient, and wrong IOLs. It is an example of moving from clinical guidelines to targeted education for practitioners who made a medical error and may not have followed the recommended guidelines in the PPP.