Clinical guideline use and compliance: examining variation from the clinical pathway

Clinical guidelines are developed with the aim of optimising patient care and have been shown to improve both clinical outcomes and the care process. ‘Hospital HealthPathways’ are guidelines published for use within Canterbury District Health Board (CDHB) hospitals. Previous research into guideline use and compliance in CDHB coined the term ‘appropriate non-compliance’, describing clinically appropriate variation from guideline recommendations. This study used a prospective methodology to observe access of and compliance with the Hospital HealthPathways Community Acquired Pneumonia (CAP) guideline and explore reasons for not accessing or not complying with the guideline. Cases of ‘appropriate non-compliance’ were identified, and a target rate of compliance quantified, taking this into account. Based on findings from the previous research, ‘Practice Points’ – bullet points for emphasis and clarity – were added to acute pancreatitis and CAP guidelines. This study also evaluated the effect of these Practice Points. Findings from the study suggested that the purpose behind a guideline recommendation might influence compliance. A survey was performed to investigate this possibility.