Guideline compliance in management of minimal, mild, and moderate XXXX : high frequency of noncompliance among individual physicians despite strong guideline support from clinical leaders.

@entity1 @entity542
BACKGROUND: The evidence-based Scandinavian Guidelines for the Initial Management of Minimal, Mild, and Moderate @entity542 were developed to provide safe and cost-effective assessment of @entity1 . A survey based on a questionnaire directed to clinical managers in all Norwegian hospitals indicated that the guidelines had influenced management practice significantly. However, implementation of guidelines and compliance from clinical leaders does not necessarily influence individual physicians decisions making. METHODS: To evaluate physicians-compliance with the Scandinavian Guidelines in individual @entity1 , we conducted a study (January 2003 to January 2004) that included all @entity1 with minimal, mild, and moderate @entity542 who presented to the emergency department in a Norwegian university hospital. Guideline compliance was evaluated in the assessment and treatment of 508 @entity1 . The management of each single @entity1 was classified as compliant with the guidelines or not. Classification as compliant required correct use of computed tomography (CT) and hospital admission in accordance with the guideline. RESULTS: The overall physicians-compliance with the Scandinavian Guidelines was 51%. A substantial overtriage with unnecessary CT examinations and hospital admissions was seen in @entity1 with minimal and mild @entity542 . Among @entity1 with minimal @entity542 , 69% underwent overtriage, 18% with unnecessary hospital admission, 27% with unnecessary CT, and 24% with both. Among @entity1 with mild @entity542 , 37% were subject to overtriage, all with admission for observation after a negative CT. All @entity1 with moderate @entity542 were treated in accordance with the guideline. CONCLUSION: Guidelines for assessment and treatment of minimal and mild @entity542 may not have the intended degree of influence on clinical practice. Even in departments where clinical managers report that the practice is evidence based, physicians may not act in accordance with this in their daily practice. This causes significant unnecessary costs, estimated as USD 2,167.000 annually in Norway.
