Key Learning Points

• Clinical policies / practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”; they “represent an attempt to distill a large body of medical knowledge into a convenient, readily usable format”. (Institute of Medicine) • Clinical policies help to differentiate “expert opinion ” from research based knowledge. • The ACEP Clinical Policies Committee was started in 1987; there are currently 15 clinical policies in existence. Average cost of development is $10,000 vs up to $2 million used by other organizations. • www.guidelines.gov is an excellent source to identify clinical policies / guidelines that are in existence. • Developing evidence based clinical policies requires focused questions with defined outcome measures. The process is encumbered by the heterogeneity of study populations and variance in outcome measures used. • Dissemination and acceptance of clinical policies has proven difficult for a variety of reasons which include difficulties with changing established practice patterns. • Early guidelines were primarily consensus based and thus influenced by bias. • Evidence based guidelines use well defined methodologies that evaluate the quality of a study and provide recommendations that are graded according to the strength of the evidence available. Different societies use different grading systems and thus it is important for the reader to understand how the recommendations were developed