title: Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians' attitudes.
abstract: OBJECTIVE
  To understand clinicians' perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies.
  
  
  METHODS
  We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians' and nurses' attitudes and preferences towards guidelines.
  
  
  RESULTS
  The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P<0.001). Physicians considered endorsement of guidelines by a colleague more relevant for enhancing guideline use than did nurses (P<0.001). Nurses considered low risk of the guideline and whether the guideline is consistent with their practice (P<0.001) to be more relevant to guideline uptake than did physicians (P<0.001). Lack of agreement with recommendations was a more important barrier to use of guidelines for physicians than for nurses (P<0.001).
  
  
  CONCLUSIONS
  Many Canadian institutions locally develop guidelines, and many ICU physicians and nurses report using them. Planning implementation strategies according to clinician preferences may increase guideline use. The nature of the differences in attitudes towards guidelines between nurses and physicians, and their impact on clinician adherence to guidelines requires further exploration.
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, and University of Toronto, Ontario M4N 3M5, Canada. taz.sinuff@sunnybrook.ca
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Eva
authors.forename: Maureen
authors.initials: M
authors.lastname: Meade
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.forename: Daren
authors.initials: D
authors.lastname: Heyland
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D003422:Critical Care / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D017410:Practice Guidelines as Topic