Poster Presentation: British International Congress in Obstetrics and Gynaecology, London, 2007

1. Clinical guidelines: a cross sectional survey of obstetricians and midwives’
knowledge, use and attitude
Montasser Mahran , Specialist Registrar in Obstetrics and Gynaecology,1 Malcolm Paine, Specialist Registrar in Obstetrics and Gynaecology,2 Ayman
Ewies, Consultant Obstetrician and Gynaecologist3
1= Stoke Mandeville Hospital NHS Trust, Bucks , UK 2 = Chelsea and Westminster Healthcare NHS Trust, London, UK 3 = The Ipswich Hospital NHS Trust, Suffolk, UK
2. The staff beliefs:
▪ In both hospitals, there was a tendency to agree with all statements
except number 5, 8 and 10.
▪ There was a significant difference about the value of guidelines as an
aid to use the most up to date knowledge (p<0.0001); 46 (58%) in the
teaching hospital disagreed with the statement in contrast to the
district hospital where 70 (70%) agreed with it.
▪ Half of the staff members in both hospitals were neutral as regards
the role the guidelines play in increasing professional satisfaction.
3. Main Barriers for lack of adherence:
• The major barrier to follow the guidelines was the lack of
comprehensiveness as documented by 70% of the respondents.
4. Suggestions to improve adherence:
▪ Using bullet points, more frequent updating and shortening the
guidelines were the commonest suggestions to improve adherence.
Comments:
▪ There is a gap between the guidelines producers and implementers,
which needs to be filled by better training and communication.
▪ The difference in responses between the staff in the teaching and
district general hospitals emphasizes on the importance to tailor
guidelines to match the working environment and the staff views
rather than rigidly dictating practice.
References
1. Eccles M, Grimshaw J, editors. Clinical Guidelines from Conception to Use. Oxon: Radcliffe
Medical Press, 2000.
2. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don't physicians
follow clinical practice guidelines? A framework for improvement. Jama 1999;282(15):1458-65.
Background
Successful implementation of guidelines should improve quality of care
by decreasing inappropriate variations and expediting the application of
effective advances to everyday practice.1 However, adherence to
guidelines may be hindered by a variety of barriers.2
Objectives
To explore the attitudes of the obstetricians and midwives towards the
maternity directorate guidelines, and to document the barriers that may
hinder their adherence and suggestions for improvement.
Setting
Chelsea and Westminster Healthcare NHS Trust (teaching
hospital) and The Ipswich Hospital NHS Trust (district general hospital).
Method
▪ A questionnaire distributed by hand and via internal mail to 295
obstetricians and midwives between 1st July and 31st of October 2006.
The questionnaire consisted of four sections asked the staff about:
*The following table represents the beliefs examined
▪ Statistical analysis was performed using GraphPad software.
Responses were compared using Fisher’s exact test and p<0.05
was considered to be significant.
Results
The response rate was 80/159 (50%) at Chelsea and Westminster and
101/136 (74%) at The Ipswich. One fifth of the respondents in both
hospitals were obstetricians
1. The staff preferred practice:
▪ Using a mixture of both guidelines and one’s own experience was the
most preferred method of practice.
1 Their preferred practice
2 Belief statements on the usefulness of guidelines
*
(The response was measured using a five-point scale)
3 Barriers for lack of adherence to guidelines
4 Suggestions to improve adherence
10%
68%
10%
19%
25%
74%
1%
8%
Lack of Time lack of
comprehensiveness
Limited Resources Against senior
decision
Ipswich Chelsea and Westminster
56%
35%
46%
51%
37% 35%
70%
63%
54%
36%
48%
65%
Bullets points Shorter Feedback
system
Announcing in
meeting
Summary Page Regular
Updating
Ipswich Chelsea and Westminster
1 Stop innovation 2 Narrow the clinical freedom
3 Reduce cost 4 Help learning
5 Reduce job satisfaction 6 Improve the quality of care
7 Create defensive practice 8 Reduce patients’ confidence in
professionals
9 Decrease competitiveness
between professionals
10 Enable to use most up to date
knowledge
0%
20%
40%
60%
80%
100%
Guidelines Own practice Mixture Other
Ipswich Chelsea and Westminster