Manual for ACC/AHA Guideline Writing Committees

Methodologies and Policies from the ACC/AHA Task Force on Practice Guidelines

Section II: Tools and Methods for Creating Guidelines

• Step Seven: Create Tables, Diagrams, and Mnemonics Describing Recommendations

The broad mandate of most guidelines ensures that guideline documents tend to be longer and less formulaic than other articles . . . [but] surveys reveal that clinicians prefer pocket cards, concise pamphlets, and journal article summaries. - Cook, 1999

Once the evidence tables and recommendations have been created, guideline writers should look for ways to visually summarize the key points in tables, diagrams, and mnemonics. The flow diagrams identified in Step One should be considered again in light of the evidence collected and recommendations written. Frequently, the text and/or recommendations can be condensed into a clinical pathway, algorithm, or decision-tool. These visual summaries assist physicians in understanding and applying the best care for individual patients. Visual presentations should be:

• Written in clear and unambiguous language.
• Logically organized.
• Easy to follow.
• Specific about relevant populations and clinical circumstances.
• Specific about which elements of care are appropriate, inappropriate, and equivocal.

The guideline users will expect the evidence to be presented as proof of the recommendations' quality. However, in clinical circumstances, the key points of how the evidence applies to patients are the take-home messages that must be clearly presented and easily accessible in the guideline.

Examples of good tables, diagrams, and mnemonics, include:

• Atrial Fibrillation Guideline, Figure 9
• Chronic Stable Angina Guideline, Figure 5
• Perioperative Evaluation Guideline, Figure 1

Preparing the Guideline for the Pocket Guide
Many of the ACC/AHA guidelines are converted into a pocket guide version to facilitate implementation of the guideline, specifically at the point of care. The information in the pocket guide should flow directly from the full guideline; thus guideline writers are responsible for ensuring that the guideline lends itself to the pocket guide format. The Task Force recommends that each writing committee designate one writer who will be responsible for the pocket guide.