Evidence-based clinical practice guidelines are recommendations for the performance or exclusion of specific procedures or services for specific disease entities. They are also one strategy to improve care by systematizing "best practices." Madigan
clinical guidelines are derived from best practice recommendations
and represent the expected care for a patient with a particular
problem. These guidelines will be used as a monitoring tool for
quality assessment and improvement because they represent the
essential elements of care for a particular problem. Guidelines
reduce errors and provide consistent quality of care and utilization
of resources throughout the system. Clinical practice guidelines are
derived through a rigorous methodological approach that includes a
systematic review of the evidence to outline recommended practice.
They are frequently displayed in the form of an algorithm, which is
a set of rules, in a flowchart format for solving a problem in a
finite number of steps. Clinical guidelines are seen by many as a
potential solution to inefficiency and inappropriate variation in
care. However, it is acknowledged that the use of guidelines must
always be applied in the context of a provider's clinical judgment
for the care of a particular patient. For that reason, the
guidelines may be viewed as an educational tool analogous to
textbooks and journals, but in a more user-friendly format.
Specialty Care Quality Management Group, Primary Care Quality Management Group, and Medical Staff Executive Committee Oversight
The Specialty Care Quality Management Group has oversight for the maintenance of the Clinical Practice Guidelines and the Medical Staff Executive Committee is the final approval authority. The role of the Specialty Care Quality Management Group in this process is defined in the committee’s charter and can be visualized on this flowsheet.
Existing Clinical Practice Guidelines must be reviewed every three years, at a minimum, and updated if necessary. A Clinical Guidelines Administrator is assigned the task of coordinating the review with the guideline champion, then submitting it to the Specialty Care Quality Management Group and the Primary Care Quality Management group for a two week review period. The purpose is to ensure it gets the widest dissemination amongst providers in the primary care and specialty care portals. After the two-week review, given that all are in agreement, the guideline is sent to the Medical Staff Executive Committee for review and approval. If consensus is not reached in the two-week review period, and additional two-week period is allotted for discussion. New Clinical Practice Guidelines undergo the same rigorous review.
Submission of Clinical Guidelines
Do you know of Clinical Management Practices, Clinical Standards or Best Practices which you currently observe that vary widely at Madigan Army Medical Center? If you have noticed a wide variety of treatments in an area of your expertise, which appear to be for the same clinical situation, please consider submitting a proposal for standardizing the management wherever possible. We encourage you to submit these in the electronic template proposal format as a Microsoft Word document. As Clinical Standards are approved, they will be published in several electronic formats, including this one. Reminders will appear electronically in several areas to direct providers to these Clinical Guidelines, and after a transition period all providers consider adhering to these standards when the clinical situation dictates. These standards are intended to make our practice of medicine more universally a "best practice" as well as improve efficiency. If you have comments or questions please contact the administrator at 253-968-3013 regarding the process of proposal submission.