Aims Clinical guidelines are important tools in promoting high quality, evidence-based practice and in reducing unnecessary variability. Difficulty physically accessing the information and lack of time to do so are among the barriers that discourage clinicians from using guidelines routinely. We aimed to increase use of the trust’s on-line paediatric guidelines by improving their accessibility from computers in paediatric A&E.
Methods We selected six paediatric guidelines relevant to the A&E department from the trust’s intranet: Fever, Head Injury, Bronchiolitis, Limp, Urinary Tract Infection (UTI), Antibiotic Policy. We determined how frequently these guidelines were viewed on-line between 1st September and 31st October 2012 using a “click-counter”. We conducted a survey of A&E staff to assess barriers to using on-line guidelines. We then installed an eye-catching icon on the A&E desktop, enabling access to the paediatric guidelines page in a single click. This allowed staff to by-pass the former, time-consuming process of clicking on seven sequential links. To advertise the system we displayed posters depicting the new icon. Between 1st September and 31st October 2013, we re-evaluated how frequently the guidelines were viewed.
Results Staff identified difficulty finding guidelines on-line, poor access to computers and time pressure as barriers to guideline use. Comparing 1st September–31st October 2013 with the same time period in 2012, total on-line views of the guidelines increased by 53% (224 v. 146). Views of head injury guidance increased over 3-fold (36 v. 10), bronchiolitis over 2-fold (47 v. 21) and fever 2-fold (22 v. 11). Views of antibiotic guidelines increased by 35% (91 v. 67). Views of limp guidance remained unchanged (no views). Views of UTI guidelines fell by 32% (28 v. 37).
Conclusion Overcoming practical problems with access to guidelines can increase their use. This is likely to improve clinical decision-making and consistency, resulting in better patient care. A single-click desk-top icon enables quick access to on-line guidelines, encouraging their use. This simple, targeted intervention is easily adopted by A&E departments. “Click-counting” is an accurate way to assess frequency of guideline views on-line and is a useful tool for evaluating effect of interventions that aim to increase guideline use.
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