Clinical Practice Algorithm
The ‘Clinical Practice Algorithm’ (CPA) is an assessed piece of work which contributes 50% of the weighted marks for the module.
The CPA is a decision making tool that is specific to your own area of practice, which explicitly describes all steps of decision making within your clinical area, from initial diagnosis to therapeutic option selection and monitoring, and everything else in between.
The creation of your CPA must be based on a full identification and critical appraisal of the literature relating to your prescribing area, including national guidelines, local guidelines and primary literature evidence.
Format
There is no one set organizational format for the final CPA document, but it must represent a detailed and intuitive guide to ALL steps of decision making for ONE CLINICAL CONDITION within your area of expertise. In other words, the CPA should take the form of a thoroughly referenced and evidence based decision making algorithm that is also clearly understandable and usable to support each step of decision making in the care of a patient within the defined clinical condition.
Steps in the decision making process
Typically, the CPA will contain an evidence-based exploration and explanation of the following steps in the decision making process:
1. A clear and unambiguous definition of the clinical condition being treated
2. Identification of patient group to be treated. What are the inclusion and exclusion criteria would you apply? Would you not treat certain patient groups (in the interest of staying safely within an area of competence)? Common exclusion criteria include – specified extremes of age, a defined level of severity or stability of a disease, excluded co-morbidness that may complicate management.
3. Diagnostic process. How are you diagnosing the condition? What information do you need? This may include: Symptoms from history taking, signs from physical examination, information from blood tests, information from imaging, information from other diagnostic tests or interventions. However, your CPA should not merely list the diagnostic indicators, it should also demonstrate how these are used in order to make a positive diagnosis (or indeed rule out a diagnosis). This may include existing validated diagnostic processes – e.g. the “Two level Wells score” for PE and VTE.
