Fistulas Begone

I was watching Grey’s Anatomy last week (my guilty pleasure), and actually saw a very interesting example of evidenced based medicine at work. Dr. Miranda Bailey, the spunky, sagely attending challenged her residents to figure out a medical protocol to eradicate fistulas in her post-op patients. The resident to come up with this winning protocol would be able to take the lead on the next laparoscopic gallbladder surgery. While all of the residents scurried off to figure out the best protocol, Dr. Bailey started analyzing the post-op patients of a particular hunky nurse (who ended up asking her out at the end of the episode-go Dr. Bailey!).

Nurse Eli's patients had a very low percentage of fistulas, and Dr. Bailey found the one commonality among the patients was that Eli would take out their drain on Day 3, instead of the standard protocol Day 5. Dr. Bailey crowed her achievement to the chief of medicine, and the episode was over. But as we know in healthcare, the work doesn’t stop after identifying correct protocol. Healthcare IT leadership has to make those evidence-based practices available in core clinical information systems, and most importantly, they need to get the buy-in from their clinicians.Dr. Bailey’s dive into evidenced-based medicine is exactly the method that Peter Basch, M.D., medical director of ambulatory EHR and health IT policy at MedStar Health used in his organization. In an interview a few months ago, Dr. Basch said that his regional healthcare system (a network of nine hospitals and 20 other health-related businesses across Maryland and Washington, D.C.) used quality reporting to identify top performing clinicians. He added that “through either observation, survey, or conversation [we] find out what it is that those providers are doing differently about their practices, or how their practice interoperates with patients, or how their patients perceive their own health, and so on. So, that’s a really interesting way to looking at reports not just for quality improvement, but for quantum quality improvement.”As HCI Editor-in-Chief Mark Hagland reports in his January cover story, which will come out later this month, hospitals and medical groups are increasingly turning to commercially-sponsored evidence-based offerings. And the drive for CPOE adoption has also hastened the need for evidence-based order sets and clinical decision support. Hagland also reports how many organizations are further customizing these order sets to meet their specific needs and situations.