Overview

The CPGs

The paediatric clinical practice guidelines (CPGs) are point of care guidelines, developed to assist clinicians with decisions about appropriate health care for children and young people. ​ This process was initiated by the Department of General Medicine and the Centre for Community Child Health and Ambulatory Paediatrics and has been in progress since February 1996.

The CPGs are designed to acquaint the reader rapidly with the clinical problem and provide practical advice regarding assessment and management. They do not constitute a textbook and therefore deliberately provide little, if any, explanation or background to the conditions and treatment outlined. Where possible, these CPGs are developed by a multidisciplinary team of practising clinicians by consensus and based on the evidence available.

CPG development and maintenance is overseen by the CPG development group, contactable at cpg@rch.org.au.

The CPG Committee

The committee is a passionate group of clinicians from General Paediatric, Emergency medicine and General practice, including medical staff (consultants and trainees), nursing staff and allied health staff largely from RCH & Monash, however also other health services across Victoria and in 2019, New South Wales and Queensland.

Committee meetings are held at RCH (and via video link) from 3-4pm on the 1^st Thursday and 3^rd Wednesday of every month.

The committee members volunteer their time to review CPG drafts and provide feedback by email and/or by attending the twice monthly CPG committee meetings. CPG drafts are circulated to the committee via email prior to the meeting. Feedback should be sent back to the CPG fellow, discussion list or CPG author, where appropriate, prior to the CPG committee meeting for that particular CPG. Feedback includes the option of an approval email from committee members, submitted to demonstrate that the CPG has been reviewed and no changes are suggested.

The discussions, online and at the meetings, are often vigorous, as the committee members are passionate, dedicated clinicians with a keen interest in the CPGs. We aim to promote enthusiastic but respectful discussions in order to develop robust evidence and consensus based guidelines in a supportive environment.

The Paediatric Improvement Collaborative (PIC)

The PIC formed in early 2018, it is a collaborative between RCH, Safer Care Victoria (SCV, Victorian Department of Health), the NSW Agency for Clinical Innovation and Clinical Excellence Queensland.

One of the main aims of the PIC is to reduce unwarranted variation in clinical care via the development, endorsement, publication and promotion evidence based paediatric clinical practice guidelines (CPGs) that outline best practice clinical management of high volume and high risk paediatric clinical conditions. The PIC oversees the transition of the Victorian Statewide CPGs to new PIC CPGs that can be used in QLD, NSW & VIC, with the hope the other states will join in the future.

Each of the states involved have appointed representatives to assist with the application of local and state based knowledge to the CPGs during the development and review process (below) ensuring relevance to all CPG users. State representatives will be involved in the extended review process as part of the CPG committee and the simple/intermediate review process through direct liaison with the CPG Development Group.

The PIC has approved the attached "Paediatric Clinical Practice Guidelines: Development and Endorsement Process"

Process

The Development and Review process:

Authors (extended review)

Committee members and other associated interested clinicians can undertake an extended review of a current CPG or develop a new CPG after discussion with the CPG development group. Topics are chosen based on the authors areas of interest and priorities determined by the PIC and RCH.

A template is provided for writing the draft CPG. The CPGs are developed or reviewed by a primary author often supported by a consultant on the CPG committee.

The support provided includes:

• Initial advice regarding the aim/s and direction of the CPG 
• Follow up support by reviewing the draft during the process and before submitting it to the committee for feedback.

The CPG is emailed to the committee for review 2 weeks prior to the committee meeting. At the committee meeting, the draft CPG is discussed from start to finish, to ensure the aim/s of the CPG are met and each point of information or advice conveys the appropriate message. This may include edits or suggested changes to language, clinical information, structure or formatting.

A final draft is completed by the original author for either resubmission to the committee, or submission for final checks by the CPG development group prior to publication on the website.

Timeline for extended review of a CPG

• Allocation of a CPG topic to the primary author at least 6 weeks prior to the scheduled date for presentation at a CPG committee meeting.
  
• Draft submitted to CPG fellow and then distributed to CPG committee via email 2 weeks prior to the scheduled date for presentation at a CPG committee meeting.
  
• Committee members can provide feedback regarding the draft via email to the distribution list or contact CPG fellow directly prior to scheduled date for presentation at a CPG committee meeting. 

The Simple/Intermediate Review Process

This process was implemented to ensure that all CPGs, particularly those less likely to change significantly over time, are up to date with content and formatting. This review includes a literature review is undertaken by a CPG fellow, with supervision by a CPG consultant. Subspecialists or relevant stakeholders may be contacted during the process for specific questions. If significant changes are required the CPG committee will be consulted.

Once this is finalised within the CPG development group, the CPG is sent to the interstate representatives for review of applicability to their state, including relevance of recommended medications and local equivalent of the suggested services and/or resources. 

Interstate representatives can involve other local reviewers in reviewing the CPG. Wider feedback received is collated by the interstate representatives before forwarding back to the CPG development group, for finalisation. From there, the endorsement process is equivalent to the extended review process.

Other Resources

Link to an NHMRC guide on writing information sheets for families.

RCH CPG developer's site