Practice Guidelines: Reinventing The Wheel

Most will agree that practice guidelines can be a good thing. Here are some of the benefits:

  • They provide a consistent way of approaching a clinical issue. Everybody working with the patient knows how things will be done, so they don’t have to remember the nuances that particular doctors or providers like.
  • They (hopefully) use the best and most valid scientific data to address the care issue, thus giving trauma professionals the opportunity to provide the best care we know of.
  • They decrease errors and complications by narrowing the number of choices available to providers.
  • They decrease waste for the same reason. For example, drawing blood every 6 hours vs daily for solid organ injuries can add up to three unneeded tests every day.
  • They provide our trainees with one good way to deal with the clinical issue. This is important when they move on to independent practice, and sometimes when taking standardized tests (boards).

To top it off, trauma verification agencies like the American College of Surgeons require trauma centers to implement ones that apply to them.

But here’s another of my pet peeves. Why does every trauma program decide to reinvent the wheel when it comes to developing them? Many organizations, particularly the Eastern Association for the Surgery of Trauma ( have done a lot of work in preparing well-researched guidelines. And I’ve published a bunch that my program has developed. Why does a hospital have to convene a work group and design guidelines from scratch?

Bottom line: If you want to use some guidelines, look at what is already out there and use that as a basis for your protocols. Yes, you will need to modify them a bit to suit your local needs. But don’t waste a lot of your time and energy when someone has already done a lot of the leg work! Don’t reinvent the wheel!

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