TY - JOUR
T1 - Lack of existing guidelines for a large group of patients in Sweden
T2 - a national survey across the acute surgical care delivery chain
AU - Muntlin Athlin, Åsa
AU - Juhlin, Claes
AU - Jangland, Eva
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Rationale, aims and objectives: Evidence-informed healthcare is the fundament for practice, whereby guidelines based on the best available evidence should assist health professionals in managing patients. Patients seeking care for acute abdominal pain form a common group in acute care settings worldwide, for whom decision-making and timely treatment are of paramount importance. There is ambiguity about the existence, use and content of guidelines for patients with acute abdomen. The objective was to describe and compare guidelines and management of patients with acute abdomen in different settings across the acute care delivery chain in Sweden. Method: A national cross-sectional design was used. Twenty-nine ambulance stations, 17 emergency departments and 33 surgical wards covering all six Swedish health regions were included, and 23 guidelines were quality appraised using the validated Appraisal of Guidelines for Research & Evaluation II tool. Results: There is a lack of guidelines in use for the management of this large group of patients between and within different healthcare areas across the acute care delivery chain. The quality appraisal identified that several guidelines were of poor quality, especially the in-hospital ones. Further, range orders for analgesics are common in the ambulance services and the surgical wards, but are seldom present in the emergency departments. Also, education in pain management is more common in the ambulance services. These findings are noteworthy as, hypothetically, the same patient could be treated in three different ways during the same care episode. Conclusions: There is an urgent need to develop high-quality evidence-based clinical guidelines for this patient group, with the entire care process in focus.
AB - Rationale, aims and objectives: Evidence-informed healthcare is the fundament for practice, whereby guidelines based on the best available evidence should assist health professionals in managing patients. Patients seeking care for acute abdominal pain form a common group in acute care settings worldwide, for whom decision-making and timely treatment are of paramount importance. There is ambiguity about the existence, use and content of guidelines for patients with acute abdomen. The objective was to describe and compare guidelines and management of patients with acute abdomen in different settings across the acute care delivery chain in Sweden. Method: A national cross-sectional design was used. Twenty-nine ambulance stations, 17 emergency departments and 33 surgical wards covering all six Swedish health regions were included, and 23 guidelines were quality appraised using the validated Appraisal of Guidelines for Research & Evaluation II tool. Results: There is a lack of guidelines in use for the management of this large group of patients between and within different healthcare areas across the acute care delivery chain. The quality appraisal identified that several guidelines were of poor quality, especially the in-hospital ones. Further, range orders for analgesics are common in the ambulance services and the surgical wards, but are seldom present in the emergency departments. Also, education in pain management is more common in the ambulance services. These findings are noteworthy as, hypothetically, the same patient could be treated in three different ways during the same care episode. Conclusions: There is an urgent need to develop high-quality evidence-based clinical guidelines for this patient group, with the entire care process in focus.
KW - abdominal pain
KW - acute care delivery chain
KW - ambulance
KW - emergency care
KW - guidelines
KW - surgical care
UR - http://www.scopus.com/inward/record.url?scp=84994530417&partnerID=8YFLogxK
U2 - 10.1111/jep.12607
DO - 10.1111/jep.12607
M3 - Article
C2 - 27491471
AN - SCOPUS:84994530417
SN - 1356-1294
VL - 23
SP - 89
EP - 95
JO - Journal of Evaluation in Clinical Practice
JF - Journal of Evaluation in Clinical Practice
IS - 1
ER -