Clinical guidelines are created by a variety of organizations to provide evidence-based recommendations on diagnosis and management of a medical condition.¹ In urology, guideline compliance is variable; poor compliance is associated with worse value-based care and/or clinical outcomes.^2-4 There has been a tremendous increase in the number of clinical practice guidelines along with the volume of professional societies creating guidelines (Figure 1). In urology, commonly referenced guidelines include the AUA, the European Association of Urology, the National Comprehensive Cancer Network, and subspecialty guidelines. Not only is the number of guidelines increasing, but the complexity is also higher (Figure 2). Multiple investigations indicate simply creating a guideline does not lead to change in clinical practice.² Thus, there is a shift in focus toward the successful implementation of guidelines. We assessed end-user feedback on electronic health record note templates to facilitate guideline-concordant evaluation and management (Figure 3).

A multiinstitutional team of urologists collaborated with the AUA Market Research and Insights group to develop a 13-question survey focused on the potential for disease-specific AUA guideline–based templates, knowledge of recent guideline changes, desired disease states for such a template, awareness of the recently updated microhematuria guidelines, and demographics.

The survey was sent out from the AUA to a cohort of AUA members, including attendings, residents, and advanced practice practitioners. The survey was left open for 4 weeks.

Of the 5,023 invitations that were sent, 497 members completed the survey (9.9%). Of the respondents, 312 (63.5%) were attendings, 40 (8.2%) were residents, and 139 (28.3%) were advanced practice practitioners. When queried whether note templates would help incorporate AUA guidelines into care, 480 (96.6%) agreed it would. Further, 468 (94.2%) respondents felt it would aid in patient education and counseling. Overall, 475 (95.6%) felt that a guideline-based note template is something they would use in practice. Lastly, 57 (11.5%) respondents were unaware of updated microscopic hematuria guidelines published in 2020.

While clinical guidelines provide evidence-based treatment pathways, the sheer number, complexity, and updating of guidelines that practicing urologists are expected to know can be a barrier to adoption. A survey of AUA members shows that a large majority feel that AUA guidelines-based note templates would help incorporate guidelines into patient care, be useful in patient counseling, and be something they would use overall. This pilot survey highlights an area ripe for intervention.