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- Evidence, guidelines and practice: the way forward in a digital age -
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- Evidence, guidelines and - Evidence, guidelines and practice: practice: the way forward in a digital the way forward in a digital age - age - SYDNEY SYDNEY 11 April, 2013 11 April, 2013 Bill Runciman Bill Runciman Professor – Patient Safety & Healthcare Human Factors – Professor – Patient Safety & Healthcare Human Factors – University of South Australia - Centre for Sleep Research University of South Australia - Centre for Sleep Research Research Fellow, Australian Institute of Health Innovation, University of NSW Research Fellow, Australian Institute of Health Innovation, University of NSW Clinical Professor – Joanna Briggs Institute, Faculty Health Sciences – Clinical Professor – Joanna Briggs Institute, Faculty Health Sciences – The University of Adelaide The University of Adelaide President, Australian Patient Safety Foundation President, Australian Patient Safety Foundation
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- Evidence, guidelines and practice: the way forward in a digital age -. SYDNEY 11 April, 2013 Bill Runciman Professor – Patient Safety & Healthcare Human Factors – University of South Australia - Centre for Sleep Research - PowerPoint PPT Presentation
Transcript of - Evidence, guidelines and practice: the way forward in a digital age -
- Evidence, guidelines and - Evidence, guidelines and practice:practice:
the way forward in a digital the way forward in a digital age -age -
SYDNEYSYDNEY11 April, 201311 April, 2013
Bill RuncimanBill RuncimanProfessor – Patient Safety & Healthcare Human Factors –Professor – Patient Safety & Healthcare Human Factors –University of South Australia - Centre for Sleep Research University of South Australia - Centre for Sleep Research
Research Fellow, Australian Institute of Health Innovation, University of NSWResearch Fellow, Australian Institute of Health Innovation, University of NSWClinical Professor – Joanna Briggs Institute, Faculty Health Sciences – Clinical Professor – Joanna Briggs Institute, Faculty Health Sciences –
The University of Adelaide The University of Adelaide President, Australian Patient Safety Foundation President, Australian Patient Safety Foundation
- The ideal healthcare - The ideal healthcare system -system -
The right thing In the right way At the right time For the right person
- - The relationship between The relationship between QALYS purchased and QALYS purchased and
expenditure - expenditure -
QALYs purchased
Expenditure
Mindlines – Daniel KahnemanMindlines – Daniel Kahneman
Acumen – pattern recognitionAcumen – pattern recognition
Reference booksReference books
GuidelinesGuidelines
Google Google
“ “Up-to-date”Up-to-date”
- The right thing? -
““Appropriate” care – 57% of Appropriate” care – 57% of
encountersencounters Guidelines Guidelines - voluminous- voluminous
- hard to assimilate- hard to assimilate
- most are out-of-date- most are out-of-date
- some overlap- some overlap
- not actionable- not actionable
- don’t usually guide- don’t usually guide
- Guidelines – CareTrack -
Indicators:Over 70% – consensus basedOnly 15% – Level I or II evidenceOnly 18% – Grade A or B
recommendations
BUTCompliance with Level I & II, A or B:
54%Compliance with consensus
recommendations: 62%
- Appropriate care - CareTrack -
- agnostic selection -
- % of - % of evidence/recommendation per evidence/recommendation per indicator modality – CareTrack indicator modality – CareTrack
--
- % of - % of evidence/recommendation evidence/recommendation per indicator modality – per indicator modality –
CareTrack -CareTrack -
Guidelines are necessary and Guidelines are necessary and
desirable – but not sufficientdesirable – but not sufficient
Internet – creates more Internet – creates more
confusion than enlightenmentconfusion than enlightenment
PCEHR – limited benefit in PCEHR – limited benefit in
assiduously documenting what assiduously documenting what
is done if we don’t know what is done if we don’t know what
to do in the first place to do in the first place
- What should we do? -
Clinical standards, indicators and Clinical standards, indicators and
toolstools
For basic care – the “at leasts”For basic care – the “at leasts”
National (& international) National (& international)
agreementagreement
Inclusive, transparent, succinct, Inclusive, transparent, succinct,
useableuseable
Conflicts of interest taken care ofConflicts of interest taken care of
Up-to-date and dynamic Up-to-date and dynamic
A wiki process – “Apps”A wiki process – “Apps”
- Proposal -
- Evidence -- Evidence - 77 RCTs/day, 11 meta-analyses77 RCTs/day, 11 meta-analyses
Some untrustworthy players - Some untrustworthy players -
reputationreputation
Systematic manipulation (bias, 24 Systematic manipulation (bias, 24
ways)ways)
Often fails to get traction in practiceOften fails to get traction in practice
Cognitive dissonance – evidence on Cognitive dissonance – evidence on
evidenceevidence
Whole area needs reconsiderationWhole area needs reconsideration
A list of do’s (“at leasts”)A list of do’s (“at leasts”) A list of dont’sA list of dont’s Standard operating Standard operating
proceduresprocedures
- screening- screening
- monitoring- monitoring
- checklists- checklists
- procedures- procedures Rehabilitation of consensusRehabilitation of consensus Restoration of HOPERestoration of HOPE
- Challenges -
- Common sense - - Common sense -
The only problem with common The only problem with common
sense is that it is not all that sense is that it is not all that
commoncommon
VoltaireVoltaire
Will RogersWill Rogers
