This study has provided data from the emergency care practice environment related to the behaviors, attitudes, preferences and knowledge about CPGs. Barriers to the uptake of CPGs across these domains were first reported by Cabana in 1999 ; many of those issues are still prevalent today in a context of many more guidelines being published on a daily basis.
The results of this study support previous research that identified that guideline formats and content are important determinants of usability of guidelines in busy clinical environments such as the emergency care sector [11–13]. A survey of multidisciplinary clinicians in Australian public hospitals reported that concise, quick-reference formats were preferred to detailed texts (35% vs. 6%; P < 0.001) [12–14]. The preferred format for guidelines identified through this survey was clinical protocols that incorporated recommendations into workflow. Understanding the practice environment is a critical aspect to consider when seeking to enhance the usability of guidelines.
The most preferred guideline attribute identified through this survey was the clear identification of key recommendations. The preferences support information related to ‘what to do, why and to whom.’ Knowledge of the CPG development process was also listed as important; the systematic approach taken to review the evidence provides a level of confidence and authority in the recommendations made.
Professional societies and peer review journals were the most frequently used sources to access CPGs. G-I-N and the National Guideline Clearinghouse (NGC) are large web-based repositories of guidelines, which were almost never used to source guidelines among the respondents; some of the reasons for this could be a lack of knowledge of these repositories or that health providers have a higher level of assurance of the quality of guidelines that are published in the peer review literature.
There was no evidence of an association between the level of service provided, e.g., tertiary care or community-based care, preferred formats or where the CPGs were accessed. However, there was a positive association between more years of practice within the setting and use of CPGs. The value of guidelines as a means of establishing standards of care and reducing variation in practice may be better appreciated as more experience is gained working within the health systems.
As the guideline development process continues to evolve, there has been an emergence of grading systems such as GRADE, which is gaining some prominence. This study revealed that 66% of the respondents were unfamiliar with the GRADE system for rating the quality of evidence and recommendations. This is supported by Kotzeva et al. [13–15], who reported that clinicians had limited knowledge, experience and understanding of GRADE. This knowledge deficit related to the grading of recommendations is potentially important as a reflection of respondent capacity to recognize and critically evaluate the approach to rating the strength of evidence used by recently developed guidelines.