They describe patterns of surgical repair for hernias before and after NICE guidance that recommended the open mesh technique over laparoscopic repair. They also assessed the impact of NICE's guidance.
They found that the NICE guidance had no impact on practice during the first year after publication, nor did it achieve the desired change in clinical practice.
Laparoscopic repair of hernias is a small part of NHS practice, but if our findings are applicable to other areas on which NICE has published guidance, NICE needs more active dissemination and implementation procedures, say the authors.
Their analysis shows that routinely collected data can be used in clinical governance. Chief executives and medical directors of trust hospitals have access to hospital episode statistics and could use these data to monitor implementation of guidance as part of clinical governance.
To improve evidence based practice in the NHS, guidance must be implemented more efficiently and clinical practice should be reviewed and monitored using well validated data, they conclude.