title: Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.|Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.|School of Nursing, University of Adelaide, Adelaide, Australia.
authors.forename: Åsa
authors.identifier: http://orcid.org/0000-0002-7221-2876
authors.initials: Å
authors.lastname: Muntlin Athlin
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.|Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Juhlin
authors.affiliation: Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Jangland
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000208:Acute Disease; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures / Q000592:standards; D004632:Emergency Medical Services / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D013548:Sweden
keywords: abdominal pain; acute care delivery chain; ambulance; emergency care; guidelines; surgical care