Clinical Practice Guidelines

Clinical practice guidelines are recommendations for clinicians about the care of patients with specific conditions. They should be based upon the best available research evidence and practice experience.
(Source: UpToDate)
The Institute of Medicine ( IOM  2011) defined clinical practice guidelines as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options."

Based on this definition, guidelines have two parts: (Source: UpToDate)
1. The foundation is a systematic review of the research evidence bearing on a clinical question, focused on the strength of the evidence on which clinical decision-making for that condition is based.
2. A set of recommendations, involving both the evidence and value judgments regarding benefits and harms of alternative care options, addressing how patients with that condition should be managed, everything else being equal
The most trustworthy guidelines can be recognized by adherence to best practices for guideline development identified by the Institute of Medicine (IOM)

Criteria for trustworthy clinical practice guidelines



1. Transparency

Guidelines should include an explicit description of process and funding.

2. Conflict of interest

Conflicts of interest for the guidelines development group should be managed by reporting, exclusion, and divestments.

3. Members of the guidelines development group

The group should be multidisciplinary and balanced.

4. Review of the literature

The guideline should be based on systematic reviews of the literature.

5. Rating strength of evidence and recommendations

Each recommendation should be accompanied by the underlying reasoning, potential benefits and harms, the evidence and its quality, the contribution of values and experience, rating of the level of confidence in the evidence and the strength of the recommendation, and differences of opinion regarding recommendations.

6. Presentation of recommendations

The guideline should state precisely the recommended actions, when they should be performed, and how they could be measured for evaluation of compliance.

7. External review

The guidelines should be reviewed by the full spectrum of relevant stakeholders. The general public should have an opportunity to review the guidelines before they are final.

8. Updating

Guidelines should state date of publication and evidence review and be updated when new, clinically-important evidence is available.

Based on data from the consensus report: Clinical Practice Guidelines We Can Trust. Institute of Medicine of The National Academies. Report available at:

 FINDING GUIDELINES — The National Guideline Clearinghouse (NGC) is a public resource maintained by the Agency for Healthcare Research and Quality (AHRQ). The NGC provides structured, standardized summaries of guidelines from most major medical organizations and clinical specialty societies and an assessment of their methodologic rigor. To be included in the NGC compendium, guidelines are required to meet specific criteria (eg, incorporate systematic review and an assessment of benefits and harms) based on the Institute of Medicine (IOM) definition of a clinical practice guideline

Australian Clinical Practice Guidelines   (Australian Government & NRMHC )
ClincalKey Clinical Practice Guidelines

International CentreInternational Centre for Allied Health for Allied Health Clearing House (University of South Australia)

iCAHE Guideline Quality Checklist  (University of South Australia)
National Guidelines Clearing House
McMasterPlus Evidence-based Guidelines     
National Health Medical Research Council (NHMRC) Guideline Standards
PubMed Clinical Guidelines
Queensland Health Maternity and Neonatal Clinical Guidelines
Royal Australasian College of General Practitioners Clinical Guidelines
Royal Children’s Hospital Melbourne Clinical Practice Guidelines
TripPro Clinical Practice Guidelines Australia and New Zealand
UpToDate Clinical Guidelines
Developing a HNE Health Policy, Procedure or Guideline
Policies, Procedures and Guidelines (PPG) Management
NSW Ministry of Health Policies and Guidelines


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Chan WV, Pearson TA, Bennett GC, et al. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Circulation. 2017 Feb 28;135(9):e122-e137 PDF

Greenfield S, Kaplan SH. When Clinical Practice Guidelines Collide: Finding a Way Forward.
Ann Intern Med.
2017 Nov 7;167(9):677-678.PDF PDF

Mercuri M, Baigrie B, Upshur REG. Going from evidence to recommendations: Can GRADE get us there? J Eval Clin Pract. 2018 Jan 5. PDF PDF

Brennan C, Greenhalgh J, Pawson R. Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines. J Eval Clin Pract. 2017 Mar 29. PDF PDF

Reddy S, Orpin V, Herring S, Mackie-Schneider S, Struber J. Use of clinical guidelines in remote Australia: A realist evaluation. J Eval Clin Pract. 2017 May 24 PDF PDF


American Academy of Pediatrics. Eigtheenth edition. Pediatric clinical practice guidelines & policies : a compendium of evidence-based research for pediatric practice. American Academy of Pediatrics: Elk Grove Village, IL : American Academy Of Pediatrics; 2018

Collins-Bride, Geraldine M, Saxe, JoAnne M, Kaplan, Rebekah, Duderstadt, Third edition. Karen G. Clinical guidelines for advanced practice nursing : an interprofessional approach. Burlington, MA: Jones & Bartlett Learning; 2017 

Tharpe Nell; Farley Cindy L, Jordan,Robin. Clinical practice guidelines for midwifery & women's health. Fifth edition. Burlington, Massachusetts : Jones & Bartlett Learning; 2017

Magnavita, Jeffrey J, editor. Clinical decision making in mental health practice. Washington, DC American Psychological Association, 2016 

Katritsis, Demosthenes. Clinical cardiology : Current practice guidelines. Updated edition. Oxford: Oxford University Press; 

Graham Robin, Mancher  Michelle , Wolman Dianne Miller, Greenfield Sheldon, Steinberg Earl,  editors. Clinical practice guidelines you can trust : Committee on Standards for Developing Trustworthy Clinical Practice Guidelines [Monograph online] Institute of Medicine of The National Academies. 2011 [cited 2018 Feb 16] Download free PDF

Australian clinical guidelines for early psychosis. Second edition. [Parkville, Vic.] : Orygen Youth Health; c2010