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To the Editor: The study by Dr Tricoci and colleagues¹ and the accompanying Editorial by Drs Shaneyfelt and Centor² both rightly justified a cautious approach to standardizing a field on a national level through the use of clinical practice guidelines. However, there is a difference between standardizing care in a field and standardizing care locally, in a hospital or within a specific unit.

Even if based on lower levels of evidence, unit-based practice guidelines may still be able to recognize that approaches are roughly equivalent, with none standing out as superior. Narrowing the choices for the sake of clarity may provide a level of consistency necessary for smooth workflow and safe practices. Variations in practice on a local level contribute to confusion. Too many choices may lead to errors: hand offs can be inconsistent and nurses and ancillary staff may have difficulty adapting. With larger practices, standardization allows for more . . . [Full Text of this Article]

Christian M. Pettker, MD
christian.pettker@yale.edu

Edmund F. Funai, MD
Yale University School of Medicine
New Haven, Connecticut

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