Assignment: Science Methodology
Assignment: Science Methodology
National attention for the need for evidence-based clinical standards for prehospital care has been growing despite the limited research on the direct benefits of existing prehospital evidence-based guidelines (EBGs), mostly because of the wealth of evidence to illustrate their contributions to improved outcomes in other medical fields and other EMSC settings.12-14 One pediatric study used improvement science methodology to improve adherence to national septic shock guidelines, consequently demonstrating improvement in process and outcome measures.15 A study of over 180,000 children with gastroenteritis found that hospitals adhering to published guidelines had 50% lower charges for ED or observation patients without adverse effects on other outcomes.16 Guidelines for diagnosis and management of bronchiolitis both in the ED and across the hospital continuum have been associated with improved outcomes through decreases in utilization of unnecessary testing and interventions, including decreases in costs.17-21
Several organizations and systems have developed strategies for minimizing unwanted variation in clinical care by utilizing systematic approaches to development of evidence-based clinical standards. Concurrently, they have described improved processes and outcomes, many of which include reduced costs.4,22-24 Thus, there is a plethora of experiential learning from clinical standards work that is applicable to the EMSC environment.
Developing clinical standards: One model
At Texas Children’s Hospital/Baylor College of Medicine, the Evidence-Based Outcomes Center has had a decade of experience in the development and implementation of clinical standards. The core elements of systematic clinical standards development are described below and are applicable to any venue of care.
Selection of a clinical topic can be determined by both importance of outcomes (as defined by high prevalence, high rate of morbidity and mortality, resource intensiveness, or wide variation in care) and organizational readiness for improvement. Internal data can help identify importance quantitatively, especially when including cost of care for each disease process being considered for clinical standards. Simply defined, organizational readiness is the institutional member’s commitment to the complex change that might ensue from development and implementation of the clinical standard;25 they must value the development process as well as the potential in order to assure ongoing engagement for development, implementation, and sustainability.
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