Guideline: A Tool to Streamline a Challenge?

Guideline: A Tool to Streamline a Challenge?

  • Issue 63

Edoardo De Robertis | Chair Guidelines Committee

ESA strongly supports the development of guidelines, which represent a systematically developed body of information and instructions with the aim to assist health care providers in the appropriate diagnosis and treatment of specific clinical situations.

ESA, through the Guidelines Committee activities, aims at:

  • Making available European guidelines to be used by individual ESA members and/or adopted by national societies for their own national use;
  • Harmonising clinical management of anaesthesiology and perioperative medicine and related areas such as intensive care, emergency medicine and pain, throughout Europe;
  • Improve standards of care throughout Europe.

Guidelines define, in fact, standard practice, contribute to safety and to transparent decision-making, and offer guidance to health care providers and patients alike. Moreover, guidelines can play an important role in health policy formation. Accordingly, appropriate methodologies and rigorous strategies, which only respected Societies can offer, are of paramount importance in the guideline development process, since the potential benefits of guidelines are only as good as the quality of the guidelines themselves.

The validity of any guideline recommendations depends on the rigor by which existing evidence has been assessed. This is an essential element if a guideline is to be trusted by clinicians and implemented into clinical practice. As G.B. Shaw wrote “Beware of false knowledge; it is more dangerous than ignorance”. The process for guideline development should be systematic, independent and transparent. Thus, to produce scientifically robust recommendations for clinical practice, it is mandatory that the authors of a guideline thoroughly examine the literature to find all significant papers, consider the classical pyramid of evidence hierarchy, but more importantly, critically evaluate all relevant evidence. And this approach is often not enough! There are cases in which recommendations for clinical practice that are highly welcomed are challenged by the interpretation of objective scarce evidence (small sample size and underpowered RCTs).

But clinicians well know that guidelines, despite their limitations, are a necessary step to homogenize clinical practice and should be followed critically, being aware that building the ‘truth’ in clinical practice is often based on uncertainty.

On this ground, the ESA Guidelines Committee operates to define the rules for making guidelines, select the topics and experts, collect and evaluate available documents throughout Europe and establish relationships with other Societies to prepare possible collaborative guidelines.

Over the last years the ESA Guidelines Committee has established several task forces to elaborate guidelines made up of experts in the relevant fields.
At the moment 6 task forces are active:

  • The task force on reduction of post-operative delirium has finalised a document, which will soon be published, to provide a practical, clinical overview of the current knowledge and practice advice on the prevention, detection, and treatment of post-operative delirium.
  • The task force on Sedation will finalise a document in the next months.
  • The task force on Prevention of venous thromboembolism in anaesthesia and intensive care includes ESA members and some representatives from major European societies on orthopaedics, general surgery, gynaecology, and obstetrics, medical intensive care, and haemostasis and thrombosis. The recommendations will deal with peri-operative (pre-, per-, and post-) VTE prophylaxis, including the ICU.
  • The Task Force for the revision of Severe Bleeding Management, which is reviewing the recent literature to update the previously published ESA Guidelines on Severe Bleeding Management.
  • The Task Force for the revision of Pre-operative Evaluation of adult patients undergoing non-cardiac surgery is reviewing the recent literature to update the previously published ESA Guideline for Pre-Operative Evaluation.
  • The Task Force for the development of the guideline on Ultrasound guided vascular access and regional blocks has recently been selected.