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- Evidence, guidelines and practice: the way forward in a digital age -

- 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

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- Evidence, guidelines and practice: the way forward in a digital age -

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  1. - 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 Research Fellow, Australian Institute of Health Innovation, University of NSW Clinical Professor – Joanna Briggs Institute, Faculty Health Sciences – The University of Adelaide President, Australian Patient Safety Foundation

  2. - The ideal healthcare system - • The right thing • In the right way • At the right time • For the right person

  3. - The relationship between QALYS purchased and expenditure - QALYs purchased Expenditure

  4. - The right thing? - • Mindlines – Daniel Kahneman • Acumen – pattern recognition • Reference books • Guidelines • Google • “Up-to-date”

  5. - Guidelines – CareTrack - • “Appropriate” care – 57% of encounters • Guidelines - voluminous - hard to assimilate - most are out-of-date - some overlap - not actionable - don’t usually guide

  6. - Appropriate care - CareTrack - - agnostic selection - • Indicators: • Over 70% – consensus based • Only 15% – Level I or II evidence • Only 18% – Grade A or B recommendations • BUT • Compliance with Level I & II, A or B: 54% • Compliance with consensus recommendations: 62%

  7. - % of evidence/recommendation per indicator modality – CareTrack -

  8. - % of evidence/recommendation per indicator modality – CareTrack -

  9. - What should we do? - • Guidelines are necessary and desirable – but not sufficient • Internet – creates more confusion than enlightenment • PCEHR – limited benefit in assiduously documenting what is done if we don’t know what to do in the first place

  10. - Proposal - Clinical standards, indicators and tools • For basic care – the “at leasts” • National (& international) agreement • Inclusive, transparent, succinct, useable • Conflicts of interest taken care of • Up-to-date and dynamic • A wiki process – “Apps”

  11. - Evidence - • 77 RCTs/day, 11 meta-analyses • Some untrustworthy players - reputation • Systematic manipulation (bias, 24 ways) • Often fails to get traction in practice • Cognitive dissonance – evidence on evidence • Whole area needs reconsideration

  12. - Challenges - • A list of do’s (“at leasts”) • A list of dont’s • Standard operating procedures - screening - monitoring - checklists - procedures • Rehabilitation of consensus • Restoration of HOPE

  13. - Common sense - The only problem with common sense is that it is not all that common Voltaire Will Rogers

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