Scotland has a national guideline production house (SIGN), which
disseminates guidelines for local protocol development.
The problem with protocols following on from guidelines is that it is
inevitably easier to know 'what to do' than to know 'how to do' (what
to do). This then leads to an implementation 'gap'.
This frustrates guideline writers who think that the hard bit has
already been done, and causes insecurity amongst those left to
develop the protocols locally.
IMHO, the critical appraisal of guidelines should include the
question:
'Have the guideline writers considered the implications for local
protocol development?'
to try and include a measure of the guidelines 'usability' in the real
world.
Ian Reeves
Training Research Fellow
Academic Dept Geriatric Medicine
Glasgow Royal Infirmary
UK
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