How Useful are Laboratory Practice Guidelines?
Clinical practice guidelines (CPGs) relating to laboratory diagnostic testing are increasingly produced with the aim of standardizing practice and improving patient care based on the best available evidence. However, the production of a CPG is merely the first step in the process of getting evidence into practice, to be undertaken by laboratories and other stakeholders. This process should evaluate the information provided in the guidelines on laboratory tests, devise a strategy for implementing the CPG or the laboratory aspects of the CPG and finally, once implemented, assess the impact of the CPG on clinical practice, patient outcomes and costs of care. The purpose of CPG evaluation by the laboratory is to determine whether sufficient information is provided on the particular test recommended. CPGs may not always be written with the involvement of a laboratory specialist and this underlies the paucity of relevant information in some national guidelines. When laboratory specialists are involved, CPGs can provide practical information which supports local laboratories as well as clinicians in the implementation and appropriate use of recommendations. Implementation of CPGs is an often neglected area that needs attention and thought. There are many barriers to successful implementation, which may vary at local level. These need to be identified early if CPGs are to be successfully adhered to. The effectiveness of CPGs also needs to be audited using process and health outcome indicators. Clinical audit is an effective tool for assessing adherence to recommendations and for measuring the impact and success of the CPG.
Diabetes, Endocrinology & Metabolism, Imperial College London , St Mary's Campus, London, UK.
S
S
Misra
Laboratory of Clinical Biochemistry, Haukeland University Hospital , Bergen, Norway.
K
K
Moberg-Aakre
Dept. Laboratory Medicine, AZ St Jan Hospital, Bruges, and Ghent University , Belgium.
M
M
Langlois
Laboratoire de Biologie Polyvalente, Hôpital de la Chartreuse , Villefranche-de-Rouergue, France.
J
J
Watine
Clinical Chemistry, St. Vincent's University Hospital , Elm Park, Dublin, Ireland.
P J
PJ
Twomey
Atrium-Orbis. Department of Clinical Chemistry and Haematology, Heerlen , The Netherlands.
W P
WP
Oosterhuis
Blood Sciences, Old Medical School, Leeds General infirmary , Leeds, UK.
J H
JH
Barth
Clin Chem. 2011 Jun;57(6):e1-e47
21617152
Atherosclerosis. 2014 Mar;233(1):83-90
24529127
Diabetes Care. 2011 Jun;34(6):e61-99
21617108
JAMA. 1999 Oct 20;282(15):1458-65
10535437
Ann Clin Biochem. 2011 Nov;48(Pt 6):558-61
21885473
Clin Chem Lab Med. 2014 Aug;52(8):e155-7
24598836
Eur Heart J. 2013 Dec;34(45):3478-90a
23956253
Diabetes Care. 2011 Jun;34(6):1419-23
21617111
Implement Sci. 2009 Aug 12;4:54
19674440
Int J Clin Pract. 2009 Sep;63(9):1320-6
19691615
Clin Chim Acta. 2014 May 15;432:27-32
24513545
Clin Chim Acta. 2014 Nov 1;437:58-61
25036763
Ann Clin Biochem. 2009 Jan;46(Pt 1):24-32
19028807
N Engl J Med. 1989 Nov 9;321(19):1306-11
2677732
Eur Heart J. 2010 Dec;31(23):2844-53
20965889
Lancet. 1993 Nov 27;342(8883):1317-22
7901634
Clin Chem. 2008 Dec;54(12):e11-79
19042984
Ann Clin Biochem. 2011 Sep;48(Pt 5):479-80
21750114
Clin Chem Lab Med. 2013 Jun;51(6):1217-26
23037517
Clin Endocrinol (Oxf). 2014 Jul;81 Suppl 1:1-122
24989897