CLINICAL PRACTICE POLICY PROTOCOL

Clinical Practice Policy Protocol Relevance To Care Delivery

Abstract

The use of clinical protocols allows health care providers to offer appropriate diagnostic treatment and care services to patients, variance reports to purchasers and quality training to clinical staff. Such protocols provide a locally agreed standard to which clinicians and the organization can work and against which they can be audited. By embedding protocols into patients' records and reporting by exception, the use of protocols may help to tackle a raft of other issues successfully such as the reduction in junior doctors' hours, and the facilitation of shared care. It may also bolster the medico-legal robustness of the health care delivered. If the protocols are sufficiently detailed, costing, coding and other resource usage information can flow directly from the clinical records. Such benefits may be maximized by using protocols within the framework of an electronic patient record system.

A quality service is one that does the right thing and does it right. In health care doing the right thing covers the issues of appropriate diagnosis, treatment and care. Doing it right addresses those of timeliness and usage of resources, labour such as clinical staff, land in terms of hospital beds for instance and equipment, examples of which include both hoists and drugs. Health care providers must aim to do the right thing in a timely manner and with due economy of resource. The use of protocols can help to achieve these objectives.

The Background to Clinical Protocols

For a few illnesses protocols are well established. For example, the British Thoracic Society's guidelines for patients with asthma are widely accepted and applied. They identify diagnostic criteria and relate the severity of disease to the need for specific drugs with suggestions both for dosage and duration of treatment. The ISIS2 study has guaranteed a place for aspirin and thrombolysis in the immediate treatment of patients with acute myocardial infarction for the foreseeable future.

Few clinical topics are so well researched, studied and circumscribed, however. The approach to the diagnosis, treatment and care of the majority of patients and illnesses remains fragmented. Senior clinicians have developed local policies to guide junior staff. Such local policies predominate where widely agreed research-based outcome-driven information as to best practice does not exist. Even where best practice has been identified adaptation for local circumstances may still be necessary. For instance, magnetic resonance imaging may provide the best way to identify areas of demyelination in multiple sclerosis but not every hospital has access to one nor the resources to refer their patients to a hospital that does. (Teboul, J. 2001, Pp. 123.)

Such local policies may be formalized as protocols or practice guidelines. Traditionally most have remained in their departments of origin. More recently the sharing of protocols between sites has become commoner. For instance a book of guidelines for interns that is produced by one leading London hospital and that covers the treatment of common medical conditions is now being offered to neighbouring hospitals, many of whom have adopted it ...