Implementatie van richtlijnen voor klinisch handelen op een afdeling chirurgie

OBJECTIVE: To evaluate implementation of clinical practice guidelines. DESIGN: Prospective evaluation study. SETTING: Department of Surgery. Academic Medical Center. University of Amsterdam, the Netherlands. METHODS: Clinical practice guidelines on patient care were developed by physicians working in the department of surgery. Six months after their introduction a selected, representative group of consecutive patients, admitted during 4 months, was followed by an independent investigator who determined compliance with a large number of guidelines. After this study period all physicians of the department were given oral and written feedback. This was followed by a period of two months during which compliance was determined again. RESULTS: In the first study period 226 patients were included. Compliance with most of the guidelines evaluated was over 70%. Compliance with the guidelines described in this article (antibiotic and thrombosis prophylaxis, use of urinary tract catheters and wound drains, diagnostics and therapy in symptomatic gallstones and distal obstruction icterus) ranged from 49% for the use of urinary tract catheters to 94% for thrombosis prophylaxis. In the second study period 106 patients were studied and no differences in compliance were found, except for the use of urinary tract catheters (from 49% to 73%). CONCLUSION: This study demonstrates that it is possible to introduce clinical practice guidelines in a surgical ward successfully and to reduce variation in patient care. Providing aggregated feedback is not sufficient to improve compliance with guidelines