Adopting Evidence-Based Medicine in the Surgical Suite

Throughout many areas of hospitals, clinical teams are beginning to tap into standardized evidence-based data so that they can implement best practices as a way to supplement the knowledge gained through experience, colleagues, and mentors. At our 302-bed hospital at Berkshire Medical Center, clinical teams have developed protocols for more than 140 different clinical care scenarios based on data from evidence-based clinical decision support (CDS) systems. Use of the CDS system has resulted in improved outcomes. Although there are many CDS solutions available, our clinical team utilizes Zynx Health CDS. Out With the Old, In With the New In an effort to replicate successes seen in other clinical care scenarios, my colleagues and I at Berkshire Medical Center collaborated with a clinical team to develop an evidence-based colectomy module. It was designed to address the perioperative management of adults undergoing colon surgery. The module included medical evidence for each stage of surgery. After reviewing the evidence, we realized that we were practicing with old principles and without standardization. For example, it was discovered that several principles needed to be changed based on the current best practice evidence, including perioperative fluid intake, reintroduction of oral antibiotics, and postoperative use of antibiotics. “The culture of quality initiatives coming from hospital committees and departments has been replaced by an environment where a multidisciplinary team develops and implements best practices.”  These practices were then modified to create a “fast track” colon surgery protocol that included techniques for reducing complications and costs while also decreasing pain, shortening length of stay (LOS), and facilitating earlier returns to everyday activities. Instead of developing committees and spending...