From Past to Future: The Evolution of ESAIC Guidelines 

In this interview, Carolina Soledad Romero Garcia, Chair of the ESAIC Guidelines Committee, reflects on the Committee’s key achievements in 2025 and outlines its priorities for 2026 and beyond, including methodological excellence, guideline implementation, international collaboration and capacity building. 

Looking back at 2025, what were the ESAIC Guidelines Committee’s main deliverables, and which achievements stand out to you the most? 

Within the ESAIC Guidelines Committee, there is a significant amount of behind-the-scenes work that goes unseen. However, the deliverables that are visible to the eye and that we are very proud to share with our community, is these two guidelines that were published in 2025.  

A very exciting milestone is that, for the first time, we have a guideline focused on obstetric patients. Whilst developing this guideline on the Management in the failing epidural during labour , we realised the limited number of randomized clinical trials that have been conducted in obstetrics, bearing in mind that almost 80% of women in Europe will become pregnant at any time in their life.  

As for the next accomplishment in the last year, it is the second clinical practice guideline that we have produced in the paediatric population, particularly the Management a neuromuscular block in anesthetized children.  

Generally speaking, the research in children is more limited and there are fewer studies than in adults. On top of this, the different stages of growth and development in the paediatric population prior to adulthood will give an extra twist when drafting recommendations.  

These achievements underscore the immense importance the ESAIC Guidelines Committee has devoted to the principles of diversity, equity, and inclusion that were outlined in the 2025 ESAIC Mellin-Olsen Declaration on Diversity, Equity, and Inclusion by prioritising topics that were not developed before along with a comprehensive panel composition assuring a balanced representation across views, countries and professional development.  

Explore ESAIC’s other achievements of 2025 in the Annual Report. 

Developing high-quality guidelines often involves collaboration with experts and scientific societies across Europe and beyond. What were some of the key challenges and successes in building these partnerships during 2025? 

The development of high-quality clinical practice guidelines requires rigorous methodology, transparency and the use of a common “evidence-based medicine language”. Indeed, the first time a guidelines panel member is in contact with some new proceedings, they might experience a degree of surprise or a sense of disbelief, even the learning curve might appear to be steeper than it is in practice. So, why these changes that may complicate things more than they were already? The case is that this approach started internationally around the 2000s, and it has been extended progressively to many prominent scientific societies and government bodies that have embraced higher quality standards for clinical practice guidelines.  

By setting better regulations, our guidance documents will empower us to adjust an evidence-based care plan for patients more effectively in our daily practice— whether with colleagues from other specialties, with the managers and directors of our hospitals, or with policy-makers who shape evidence-based healthcare policies. 

“Ultimately, the key in Guidelines is to ensure transparent decision-making by adopting replicable and traceable methods and minimising conflicts of interest.”

Throughout 2025, one of the greatest strengths lay in the integral coordination of guidelines tasks and derivative products in ways that are universally accepted among the evidence-based community, but also by being coherent, consistent and interoperable across projects.  

A key success was the harmonisation of the methodological framework, and the development of a portfolio of types of guidance documents that are ranked according to their methodological rigour, which also reflects the degree of certainty we have regarding the recommendations set out in all ESAIC guidance documents (Clinical practice guidelines, Consensus Documents, Statements and Technical reports). This fact, which at first appears to have only internal implications for ESAIC, is in fact the bridge that enables us to connect with other international societies that adhere to the same methodological principles.  

The next ESAIC Guidance documents will also broaden access to specialist expertise, thereby strengthening the credibility and applicability of the resulting recommendations. By forging partnerships with leading experts and scientific societies across Europe and beyond, the ESAIC Guidelines Committee will bring together diverse perspectives around shared evidence-based standards.   

However, significant challenges also came to light. Coordinating stakeholders across different countries, healthcare systems and traditional guidelines approaches often slowed down the process. At the same time, reconciling divergent clinical practices require patience and careful negotiation. Limited resources and the fact that some work was carried out on a voluntary basis occasionally led to delays in timetables. Despite these obstacles, continuous dialogue and mutual trust ultimately led to well-founded, widely supported guidelines. 

Building on the progress made in 2025, what are the Committee’s key priorities and areas of focus for 2026 and beyond? 

First and foremost, we will continue to streamline our workflows, which are now fully centralised within a unified system that ensures the high quality of the data stored. This centralisation enhances efficiency across all guideline development activities and will be the basis for more pragmatic updates to the guidelines, that could be even more optimistic by using artificial intelligence in our procedures.  

“Implementation target: Think then act!”

A second key priority is implementation – putting knowledge into practice. All too often, there is a gap between theoretical findings and day-to-day clinical practice. Our aim is to bridge this gap and ensure that our recommendations lead to tangible improvements in patient care at the bedside. By focusing on a fewer number of recommendations but that are based on high quality guidance documents, we intend to turn our guidelines not merely into documents setting out lofty goals, but into living tools that shape decisions in clinical practice and that can be intertwined with other ESAIC initiatives.  

Finally, we remain strongly committed to training and capacity building. We will continue to train ESAIC members in the methodology of guideline development and equip them with the skills to critically evaluate evidence. In doing so, we aim to nurture a new generation of clinicians who can independently assess interventions and medicines – professionals who possess sharper judgement, adopt a more rigorous approach and, ultimately, make wiser decisions. These critically thinking skills become critically important and truly indispensable in times of economic hardship and amid a very competitive healthcare market.  

Together, these priorities reflect our enduring vision: to advance safer, more effective, and evidence-driven care through excellence in methodology, meaningful implementation, and the development of clinical expertise in evidence-based medicine for years to come.