title: Wrong guidelines: how to detect them and what to do in the case of flawed recommendations.
abstract: Any evidence-based recommendation needs careful assessment of its methodological background as well as of its content trustworthiness, especially given that following it will not necessarily produce the intended clinical outcomes. There are no established instruments to evaluate guidelines for their content, while useful tools assessing the quality of methods followed are well recognised and adopted. We suggest a 'safety bundle' considering methodological aspects and content trustworthiness of guidelines, by adopting the GRADE method in a backward fashion. Sharing the critical analysis of the guidelines with patients, including any eventual uncertainty about them, is of key importance in order to avoid the possible adverse effects derived from following the wrong guidelines. Such critical approach is also helpful and beneficial in producing better care pathways, health policy decisions and more relevant and ethical research.
authors.affiliation: Emergency Department, Ospedale del Tigullio, Lavagna, Italy.
authors.forename: Primiano
authors.initials: P
authors.lastname: Iannone
authors.affiliation: Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Dipartimento di Scienze Cliniche e di Comunità Università' degli Studi di Milano, Milano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Costantino
authors.affiliation: Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Dipartimento di Scienze Cliniche e di Comunità Università' degli Studi di Milano, Milano, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Montano
authors.affiliation: U.O. Medicina III Ospedale San Paolo, Milano, Italy.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Podda
authors.affiliation: Emergency and Intensive Care Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Minardi
authors.affiliation: Emergency and Intensive Care Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
authors.forename: James
authors.initials: J
authors.lastname: Doyle
authors.affiliation: GIMBE Foundation, Bologna, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Cartabellotta
mesh_terms: D006801:Humans; D061214:Patient Safety; D017410:Practice Guidelines as Topic / Q000592:standards