Practicing evidence-based medicine is one of the key factors in achieving patient safety and delivering quality care. Rick Waller, MD, medical director of surgery at Providence St. Vincent Medical Center in Portland, Ore., decided to promote evidence-based medicine in the operating room by standardizing physician order sets.
Dr. Waller decided to launch the order set standardization initiative after attending a class by Brent C. James, MD, executive director of the Institute for Health Care Delivery Research and vice president of medical research and continuing medical education at Intermountain Healthcare in Salt Lake City. Dr. James made a "plea for standardization" and explained how it could improve patient safety and reduce waste, Dr. Waller says.
In 2008, Dr. Waller launched the initiative to standardize postsurgical order sets in four Portland-area hospitals — including Providence St. Vincent Medical Center — that are part of Renton, Wash.-based Providence Health & Services. His first step was to aggregate all physicians' individual order sets for each procedure to create a master order set. Surgeon and initiative leaders then agreed on one standard set for each procedure based on evidence-based medicine. "We hardwired [evidence-based practice] into our processes," Dr. Waller says. For example, the order set included a recommendation by the Surgical Care Improvement Project that patients receive an antibiotic within an hour of operation to reduce the risk of infection. Through this process, Providence St. Vincent reduced the total number of order sets from approximately 1,500 to 55, according to Dr. Waller.
Dr. Waller gave surgeons a choice of using the new order sets or continuing to use the old sets. In about 10 months, 97 percent of surgeons voluntarily used the new order sets, at which point the old sets were removed. "The doctors listened to reason," Dr. Waller says. "The reason was the scientific evidence published in literature they were familiar with and [which they] considered to be expert opinion."
By 2010, Providence St. Vincent had significantly reduced surgical complications and errors, based on data from the American College of Surgeons. The hospital reduced colorectal surgical site infections by more than half to 11 percent, decreased the rate of blood clots in general surgery patients from 1.24 percent to .42 percent and reduced the rate of painful urinary tract infections from 1.75 percent to 0.99 percent, according to a hospital news release. Regarding buy-in from surgeons, Dr. Waller says, "The evidence was so convincing that at that point on, getting it to take hold elsewhere became easy." Now, Providence Health & Services is beginning to implement the standardization across its 27 hospitals.
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Dr. Waller decided to launch the order set standardization initiative after attending a class by Brent C. James, MD, executive director of the Institute for Health Care Delivery Research and vice president of medical research and continuing medical education at Intermountain Healthcare in Salt Lake City. Dr. James made a "plea for standardization" and explained how it could improve patient safety and reduce waste, Dr. Waller says.
In 2008, Dr. Waller launched the initiative to standardize postsurgical order sets in four Portland-area hospitals — including Providence St. Vincent Medical Center — that are part of Renton, Wash.-based Providence Health & Services. His first step was to aggregate all physicians' individual order sets for each procedure to create a master order set. Surgeon and initiative leaders then agreed on one standard set for each procedure based on evidence-based medicine. "We hardwired [evidence-based practice] into our processes," Dr. Waller says. For example, the order set included a recommendation by the Surgical Care Improvement Project that patients receive an antibiotic within an hour of operation to reduce the risk of infection. Through this process, Providence St. Vincent reduced the total number of order sets from approximately 1,500 to 55, according to Dr. Waller.
Dr. Waller gave surgeons a choice of using the new order sets or continuing to use the old sets. In about 10 months, 97 percent of surgeons voluntarily used the new order sets, at which point the old sets were removed. "The doctors listened to reason," Dr. Waller says. "The reason was the scientific evidence published in literature they were familiar with and [which they] considered to be expert opinion."
By 2010, Providence St. Vincent had significantly reduced surgical complications and errors, based on data from the American College of Surgeons. The hospital reduced colorectal surgical site infections by more than half to 11 percent, decreased the rate of blood clots in general surgery patients from 1.24 percent to .42 percent and reduced the rate of painful urinary tract infections from 1.75 percent to 0.99 percent, according to a hospital news release. Regarding buy-in from surgeons, Dr. Waller says, "The evidence was so convincing that at that point on, getting it to take hold elsewhere became easy." Now, Providence Health & Services is beginning to implement the standardization across its 27 hospitals.
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