Abstract
Many reports on guidelines for investigation describe either the guidelines themselves or their implementation. Implicitly these assume that there has been general agreement about the guidelines, whereas there may be uncertainty about the appropriateness of a particular investigation in a given situation. We report the use of a technique for developing guidelines which explicitly seeks to identify areas of agreement and disagreement, and focuses on the reasons that particular decisions were made and the causes of disagreement.
References
1.
Legg
EF
. The on-call service: A regional survey . Ann Clin Biochem
1989 ; 26 : 19 –25 .
2.
Gyde
OHB
Leyland
MJ
. Reducing the use of laboratory tests . BMJ
1986 ; 292 : 1462 .
3.
Morgan
DB
Gunn
IR
Faye
S
Clegg
G
Grant
AM
. A comparison of alternative arrangements for an out of hours chemical pathology service . Lancet
1985 ; i : 859 –61 .
4.
Lester
E.
Out-of-hours laboratory investigations . Lancet
1985 ; ii : 500 .
5.
Sandler
G.
Do emergency tests help in the management of acute medical admissions?
BMJ
1984 ; 289 : 973 –7 .
6.
Young
RM
Payne
RB
. Effectiveness of out-of-hours biochemistry investigations . BMJ
1981 ; 283 : 289 –91 .
7.
Charpak
Y
Blery
C
Chastang
C
Usefulness of selectively ordered pre-operative tests . Med Care
1988 ; 26 : 95 –104 .
8.
Lowe
RA
Wood
AB
Burney
RE
MacKenzie
JR
. Rational ordering of serum electrolytes: Development of clinical criteria . Ann Emerg Med
1987 ; 16 : 260 –9 .
9.
Feinstein
AR
. The ‘chagrin factor’ and qualitative decision analysis . Arch Intern Med
1985 ; 145 : 1257 –9 .
10.
Lester
E.
A new strategy for out-of-hours laboratory investigations . Ann Clin Biochem
1986 ; 23 : 497 –50 .
11.
Smith
ADS
Shenkin
A
Dryburgh
FJ
Morgan
HG
. Emergency biochemistry services—are they abused?
Ann Clin Biochem
1982 ; 19 : 325 –8 .
12.
Ashley
JSA
Pasker
P
Beresford
JC
. How much clinical investigations?
Lancet
1972 ; i : 890 –2 .
13.
Glaser
EM
. Using behavioural science strategies for defining the state-of-the-art . J Applied Behav Sci
1980 ; 16 : 79 –92 .
14.
Scott
EA
Black
NA
. When does consensus exist in expert panels . J Publ Health Med
1991 ; 13 : 35 –9 .
15.
Fraser
CG
Woodford
FP
. Strategies to reduce the test-requesting patterns of clinicians . Ann Clin Biochem
1987 ; 24 : 223 –31 .
16.
Eisenberg
JM
. The state of research about physicians’ practice patterns . Med Care
1985 ; 23 : 461 –83 .
