Development and implementation of Victorian prehospital Clinical Practice Guidelines: The supraventricular tachycardia example

Background In order to provide an evidence-based approach to practice, the Ambulance Victoria (AV) Clinical Practice Development Committee (CPDC) is tasked with periodic review of all of the AV Clinical Practice Guidelines (CPG’s). This paper will highlight the framework underpinning CPG development in a Victorian prehospital emergency care system, and explore the development of CPG A0403 (supraventricular tachycardia) as an example of the process. Methods The CPDC applied a newly developed process, based upon national and internationally accepted methods of guideline assessment and development. Literature review, analysis of current practice data and extensive expert consultation were also used to formulate Guidelines. Results The CPDG delivered a revised CPG which removed calcium channel blocker therapy, introduced adenosine, and expanded the use of vagal manoeuvres to all operational paramedics. The VACIS data highlighted low intervention rates using pharmacology and vagal manoeuvres, with accepted reversion rates where applied. No logistic or safety issues were identified for the proposed changes, and expert consultation also supported changes to the guideline. Conclusion The development and implementation of new clinical guidelines in Victoria has evolved to embrace evidence based practice. The paucity of available prehospital-specific evidence means that consensus is still relied upon to complete the process, yet the evolution of further research will help to reduce reliance on this aspect and improve the quality and effectiveness of the process.