Using the Guidelines

The SQUIRE guidelines are not exclusive of other guidelines. For example, an improvement project or effectiveness study that used a randomized controlled trial design should seriously consider using both the CONSORT and the SQUIRE guidelines. Likewise, an improvement project that uses observational or qualitative techniques should consider both the STROBE guidelines along with the SQUIRE guidelines. The SQUIRE guidelines are synergistic with other publication guidelines, and together these will produce a more complete manuscript than either set of guidelines alone.  Please visit the EQUATOR network website for information on other reporting guidelines.

The Explanation and Elaboration (E&E) document includes a range of study designs in the examples. Some examples relate improvement efforts at single institutions, some are multicenter trials, and one reports on simulation activities to plan an intervention. In choosing these examples we made an effort to reflect the heterogeneity that currently characterizes the reporting of quality improvement work.

Use the E&E as a reference to assist with your writing. If you are a novice author writing about improvement using the SQUIRE guidelines, we recommend reading the entire E&E to become familiar with all of the sections and the interactions and associations between the sections. If you are a veteran writer of manuscripts, perhaps you will scan the E&E sections and delve deeper into some of the aspects of SQUIRE that are unique from other manuscript writing such as Intended Improvement (Item #5), the description of the Setting (Item #8), or the Outcomes regarding the evolution of the intervention (Item #13a).

This E&E is not primarily intended to guide your choice of methods, design, or analysis for conducting improvement work, but rather as a guide for writing about improvement; however, many of the elements included may be useful during the planning and executing of an improvement project. Some of the sections of this E&E contain more information about design than others. It may be helpful to use the SQUIRE guidelines themselves and the E&E to write an article "shell" as the project is unfolding. This could ease the final preparation of the manuscript for submission.

Although the SQUIRE checklist contains 19 distinct sections, authors (or journal editors) may wish to combine information from two or more sections depending on the flow of information or per specific journal requirements. We recommend using guidelines to describe the project clearly, not to strictly adhere to each guideline item. We caution against using the guidelines too rigidly.

Because many of the guideline items contain a large amount of information, strictly adhering to them would produce a manuscript that is likely far too long for many journal requirement (i.e., usually about 3,000 words). Some items can be summarized as a table (#13a. Outcomes), figure (#12 Analysis and #13b. Outcomes), list, or flow diagram (#4 Local Problem or #8 Setting). We encourage authors to be cognizant of combining sections in order to keep manuscripts concise and clear. Although each of these items should be addressed, each item need not be a separate header or sub header. These guidelines are best used as a way of checking the completeness, accuracy, and transparency of drafts.