Mina Azizzadeh
1 
, Ali Jannati
1 , Farzad Rahmani
1 , Daniz Naghibi
2 , Arezoo Abdi
2 , Kavous Shahsavarinia
3 , Akbar JavanBiparva
4* 1 Iranian Center of Excellence in Health Management, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Sina Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
4 Student Research Committee, Iranian Center of Excellence in Health Management, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. Clinical guidelines are texts developed to assist both physicians and patients in deciding on the most appropriate health care. This study aimed to evaluate the compliance of emergency performance with clinical guidelines at Sina Medical Training Center in Tabriz.
Methods. This descriptive-analytical study was conducted on a case study at Sina Hospital affiliated with Tabriz University of Medical Sciences. In the first stage, a checklist, approved in terms of validity and reliability, was used as a research tool to evaluate the clinical guidelines. The second phase of this study was cross-sectional, conducted in a period of one month. All medical records of people referring to level 1 and 2 triage were reviewed based on the checklist, and the data were entered into SPSS software. Since the normality of the data was confirmed, descriptive statistics and parametric tests (t-test and ANOVA) were used to analyze the data.
Results. Considering the mean (1.72±0.097) obtained in this study, the adherence to clinical guidelines was probably higher than the average. The results also showed that there was no significant relationship between the demographic variables and the mean score of total compliance with the guidelines (P-value> 0.05). As for other variables, however, it was found that the place of patient's visit as well as the time and type of patient assignment had a significant relationship with the average score of total compliance with the guidelines (P-value<0.05). The results from the regression test revealed that the patient’s place of visit was the only variable able to predict the average of the total observance of emergency clinical guidelines (P-value<0.05).
Conclusion. Taking into account the effects of influential variables (e.g., location of the patient's visit as well as the time and type of patient assignment) on the observance of the guidelines and improvement of these variables’ situation, the average observance of clinical guidelines may have been considerably improved.
Extended Abstract
Background
Clinical guidelines, as products of knowledge, are specifically developed to improve the provision of clinical services. They not only provide professional assistance to physicians and patients but also help policymakers and governments to control the cost and prioritize health care. So, clinical guidelines are as important as the quality of health care for cost-effectiveness, and they are an effective tool for avoiding unnecessary treatment and additional costs. Numerous studies have shown that an evidence-based modeling is used in clinical guidelines in order to provide services and accelerate knowledge translation, improve the quality of services in the health system, avoid unnecessary interventions and reduce health costs, promote cost-effective measures, reduce medical malpractice, settle the differences of opinions over clinical practice and clinical judgment based on logic, increase efficiency, and focus on quality control processes, including effective clinical auditing.
Methods
This descriptive-analytical case study was conducted at Sina Hospital affiliated with Tabriz University of Medical Sciences. In the first stage, a checklist as the research tool was prepared in accordance with the guidelines issued by the Ministry of Health for a comprehensive emergency visit and based on common cases referred to this hospital (5 cases), which was approved in terms of validity and reliability. The second phase of this study was cross-sectional conducted within a period of one month. All medical records of people referring to level 1 and 2 triage (examples of comprehensive emergency guides) were reviewed based on the checklist, and then the quantitative results were entered into SPSS software. Finally, the degree of adherence of physicians working in the emergency department to the standards considered by the Ministry was determined by using descriptive statistical methods and related statistical tests (i.e., parametric tests).
Results
Considering the use of scale (no=3, relative=2, yes=1) in determining the degree of adherence to clinical guidelines, the closer the total average is to 1, the degree of adherence to clinical guidelines is evaluated at the desired level. Taking into account the mean (1.72±0.097) in this study, the rate of compliance with clinical guidelines was above the average. In terms of demographic variables, women accounted for the largest portion of our sample (75.3%). The highest age range of physicians was 41 to 45 years (63.9%), and they were found to be emergency medicine specialists (66.1%). Furthermore, 72.9% of the participants had over five years of work experience. Since the significance level in Shapiro-Wilk test was higher than 0.05, the normality of the data was confirmed. Therefore, parametric tests were used to determine the relationship between the total mean and the variables; the results showed that there was no significant relationship between the demographic variables and the mean score of total compliance with the guidelines (P-value>0.05). Evaluation of the other variables also revealed that the place of patient's visit as well as the time and type of patient assignment had a significant relationship with the average score of total compliance with the guidelines (P-value<0.05). The results of regression test showed that there was only a statistically significant relationship between the patient's place of visit and the total average of adherence to emergency clinical guidelines. In other words, the patient’s place of visit was the only variable able to predict the average total adherence to emergency clinical guidelines (P-value<0.05).
Conclusion
It was concluded that the proper implementation of the guides resulted in the provision of quality services in given center. It was also found that the clinical guidelines helped the physicians and patients make right decisions and prepare for the treatment process adequately. Finally, it was determined that the errors typically occurring in abnormal, undesirable, and unpredictable conditions may have been prevented by creating a framework for them.