Dr. Pronovost argues guideline developers should re-examine their approach to evidence-based therapy and focus more on implementation efforts to help curb rates of preventable harm. His specific recommendations include:
1. Reducing guidelines to a prioritized checklist. Evidence for therapy guidelines is often published in scholarly documents, sometimes exceeding 100 pages. Many interventions are recommended in the documents, but they are not always prioritized by strength of supporting evidence. Guideline developers can increase transparency and reduce ambiguity by developing prioritized checklists with best practices on implementing given interventions.
2. Helping physicians identify and resolve barriers to implementation. Common barriers to guideline adherence include lack of knowledge or awareness of the guidelines, disagreement with the guidelines and lack of ability to comply with the guidelines. Each barrier requires a different mitigation strategy. After physicians and researchers identify the issues, they can develop strategies to overcome them.
3. Developing guidelines for co-existing conditions. Patients are often at risk for several conditions at the same time, yet current guidelines only focus on individual diagnoses. Guideline developers can create integrated guidelines for some of the most common co-morbid conditions to simplify the number of recommended interventions.
4. Using technology to help ensure therapy delivery. Technology is a tool that can supplement human action. For example, instead of solely relying on nurses to measure a hospital bed and elevate it 30 degrees to reduce the risk of ventilator-associated pneumonia, a technological tool could automatically adjust the bed.
5. Implement transdisciplinary research teams. Transdisciplinary research teams can help examine and implement more holistic and comprehensive guideline strategies.
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