Monday, December 27, 2010

How can we leverage adherence to best practice in the hospital? New findings in 2010

St. Louis City Hospital

Poor uptake of evidence in clinical practice has been a stubborn problem. Many solutions have been offered, with disappointing results. Up until this year the impact has been confined mainly to process measures and has been modest at best. But a paper published early this year reported on a process improvement initiative which more than doubled the rate of adherence over two years. More than that, it resulted in an improvement in mortality and it came from, of all places, industry. It was, of course, the Surviving Sepsis Campaign.

I've hammered at this issue before and pointed out that the Surviving Sepsis Campaign, described by NEJM Perspective piece writers as little more than marketing disguised as evidence based medicine, is one of the most maligned promotional campaigns in all of industry. The lesson here is that industry collaboration, though not a politically correct option these days, may provide opportunities to leverage better adherence to evidence.

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