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Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

[Guide de pratique clinique dans les unités de soins intensifs : un sondage sur les attitudes des cliniciens canadiens]

Tasnim Sinuff, MD PhD^*, Kevin W. Eva, PhD, Maureen Meade, MD MSc^,, Peter Dodek, MD MHSc, Daren Heyland, MD MSc^¶ and Deborah Cook, MD MSc^,

^* From the Department of Critical Care & Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, & Interdepartmental Division of Critical Care, University of Toronto, Toronto Ontario; the
Department of Clinical Epidemiology & Biostatistics, and
Medicine, McMaster University, Hamilton, Ontario; the
Department of Medicine & Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia; and the
^¶ Department of Medicine, Queen’s University, Kingston, Ontario, Canada.

Address correspondence to: Dr. Tasnim Sinuff, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Room D131, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Phone: 416-480-6100, ext 7694; Fax: 416-480-4999; E-mail: taz.sinuff{at}sunnybrook.ca

Purpose: To understand clinicians’ perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies.

Methods: We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians’ and nurses’ attitudes and preferences towards guidelines.

Results: The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P < 0.001). Physicians considered endorsement of guidelines by a colleague more relevant for enhancing guideline use than did nurses (P < 0.001). Nurses considered low risk of the guideline and whether the guideline is consistent with their practice (P < 0.001) to be more relevant to guideline uptake than did physicians (P < 0.001). Lack of agreement with recommendations was a more important barrier to use of guidelines for physicians than for nurses (P < 0.001).

Conclusions: Many Canadian institutions locally develop guidelines, and many ICU physicians and nurses report using them. Planning implementation strategies according to clinician preferences may increase guideline use. The nature of the differences in attitudes towards guidelines between nurses and physicians, and their impact on clinician adherence to guidelines requires further exploration.

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