Mr Brendan Schultz1,2, Dr Timothy Barker3, Dr Emma Bosley2,4, Prof Zachary Munn3
1Queensland Ambulance Service, Kedron, Australia, 2JBI, School of Public Health, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, Australia , 3Health Evidence Synthesis, Recommendations, and Impact (HESRI), School of Public Health, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, Australia, 4School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia, Kelvin Grove, Australia
Biography:
Brendan is operational paramedic, PhD candidate and clinical guideline developer with the Queensland Ambulance Service. In his current role, he oversees the development and implementation of clinical practice guidelines (CPGs) utilised by ambulance clinicians in Queensland. Brendan is currently completing a PhD on out-of-hospital CPGs with the University of Adelaide.
Abstract:
Background
Poorly developed clinical practice guidelines (CPGs) present an emergent patient safety risk. These documents inform the treatment provided by paramedics, emergency medical technicians and first responders, but their quality remains uncertain. This scoping review aims to identify, aggregate, and describe all literature that have assessed the methodological rigour and overall quality of out-of-hospital CPGs.
Methods
This study was conducted using the JBI methodology for scoping reviews and involved systematically searching the following databases and/or information sources with no publication or language limit applied: MEDLINE (Ovid), Embase (Elsevier), CINAHL with full text (EBSCO), Scopus (Elsevier), ProQuest Central (ProQuest).
Results
This review identified 15 articles that appraised 311 unique out-of-hospital CPGs. Notably, 65 were developed by Council of Ambulance Authorities (CAA) agencies. Of these, 40% (26/65) were assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) instrument. The average domain 3 score (rigour of development) was 19.8% (SD = 23.4). This was significantly lower than out-of-hospital CPGs developed by national institutes (76.7%, SD = 11.1), professional medical societies (57.8%, SD = 21.7), academic groups (49.2%, SD = 18.3), national emergency medical service groups (39.0%, SD = 23.9) and non-CAA ambulance services (29.8%, SD = 20.9) (p <0.001). The remaining 39 CAA CPGs were appraised against the National Health and Medical Research Council (NHMRC) standards for guidelines, with 0% meeting all criteria.
Conclusions
CPGs developed by CAA services are low methodological quality and do not meet national standards. To ensure patients receive treatment that is evidence-based, urgent action is required.