Clinical practice guidelines are an effective way of disseminating knowledge. The best CPGs represent the culmination of research in a field translating into clinical practice and improved patient outcomes.

Guidelines are generally produced by specialty societies and our young specialty has lagged other more established domains of medicine (GI, oncology, cardiology).

The PECARN decision tool is a great example of knowledge translation (while not a CPG) that has been integrated into sites like med-calc and is used by ED providers across the country. With the upcoming release of the revised AHA guidelines we will learn what we need to change about how we do PALS (coming in October). AHA is a leader in this field with a well-defined and established process for developing guidelines. The IOM has described best practices for CPG development, but many pediatric groups do not adhere to these (likely due to the lack of funding that organizations like the AHA has).

I am currently working with a diverse group (surgeons, nurses, docs, researchers) to develop a set of guidelines related to the evaluation of child abuse in the ED. This group came together after a number of institutions presented QI projects relating to this topic at last years Pediatric Trauma Society meeting. While we noted some overlap we also recognized wide variations in the guidelines (including the development and implementation process).

Our stakeholders represent some of the leading children’s hospitals in the US and we each had created our own guideline. When we reached out to the trauma listserv on this topic we quickly received over 40 different guidelines. Each of these guidelines focused on a “local” solution to the problem of to creating an evidence supported clinical practice guideline (CPG) to aid in decision-making and practice related to evaluation of physical child abuse in children presenting to the ED. As we try to work with community EDs on this same topic we see even more variation in what is out there.

Developing and implementing guidelines involves a step-wise process that can be long and costly. Unfortunately many times by the time the guideline is in use it is outdated. PEM needs to

Great examples of shared resources are the work by CHOP and Cincinatti children’s

Groups like Solutions for Patient Safety are beginning to make strides in bringing down walls between institutions related to quality and safety. Groups in PED (the sepsis collaborative) are beginning to forge a path into this collaborative work outside of the traditional research domains of PECARN. Hopefully these efforts will lead to improved collaboration throughout pediatric subspecialty groups and societies.