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Guidelines in clinical practice
  1. PETER WILKINSON, Consultant Cardiologist
  1. Ashford Hospital, Ashford, Middlesex TW15 3AA, UK

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    Guidelines in clinical practice, Allen Hutchinson, Richard Baker, eds. pp 207. Radcliffe Medical Press, 1999. £18.95, paperback. ISBN1-85775-088-8. ****

    Variations in practice, difficulty in keeping up with the medical literature and the slow introduction of new ideas into clinical practice are some of the factors that have led to the development of guidelines over the last decade. A veritable industry of guideline production has appeared, with many hours spent in creating them and trying to put them into practice. Many of them, however, have ended up in drawers or on shelves and have had little impact on the practice of clinical medicine.

    This valuable book tells us how we could do better. Several of the authors remind us that the production of guidelines is complex, time-consuming and expensive. It is therefore unlikely that local groups have the ability to create high quality guidelines and they should use their time more effectively by making minor changes to national guidelines so that they are appropriate for local use. Two chapters in this book are particularly useful as they provide details culled from practical examples in the field. Other chapters include descriptions of how to implement guidelines and urge a managed strategy which should include mechanisms for monitoring how effective the guidelines are in practice. This is a timely and instructive book as NICE is starting to produce national guidelines which we must hope will abide by the advice given here. The book should be read by all those who are going to be involved in the production of national guidelines and who will be responsible for moulding and implementing them locally.

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