With over 21.5 million unique articles and more than 1 million randomized controlled trials indexed in MEDLINE as of 2014 and more than 1 million new publications published and indexed annually, clinicians now must process a vast volume of medical literature. Many clinicians feel like they are drowning in information. Hospitalists must balance the need to find relevant and accurate answers to their clinical questions with the need for efficiency in finding those answers to immediately guide high-quality care to multiple acutely ill patients. Formulating and answering questions efficiently and effectively will improve care and reduce the rates of consultation, testing, and potential errors.
The volume of data and limited time for searching for answers compound each other. A recent systematic review examining clinical questions raised by clinicians at the point of care found approximately one clinical question arises for every two patient encounters. Clinicians only pursued 51% of the questions raised and found answers to only 78% of those questions pursued. Studies reported the main barriers to seeking information included a clinician’s lack of time and a doubt that a useful answer existed. The state of relying on information already known prevails when the energy required to get a new answer outweighs the perceived benefit. Clinical inertia may be illustrated by considering the gap between the potential benefits of evidenced-based care and actual rates of implementation as in the treatment of heart failure with reduced ejection fraction (HFrEF). Optimal implementation of strong evidence-based therapies for HFrEF could save an estimated 35,000 to 117,000 thousand lives per year. See Chapter 129 (Heart Failure).
In an ideal practice setting, the majority of clinical questions would have a readily accessible, evidence-based answer. Clinicians would have current knowledge of guideline-based therapy and could apply pertinent point-of-care reminders from the electronic medical record for best practice for every patient under their care. As a result, patients would yield maximal benefit from clinical trials and guideline-driven information. This ideal state may not be attainable; however, clinicians may take steps toward better utilizing the evidence-based answers currently available to meaningfully impact clinical practice.
CURRENT CONSEQUENCES AND MOTIVATORS FOR CHANGE
PRACTICING WITH OUTDATED INFORMATION
Relying on outdated information for patient care (ie, clinical inertia) may limit potential benefits of current therapies and expose patients to risks of disproven therapies. An example would be practicing based off outdated guidelines for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) risk in adults where a clinician tailors treatment and statin dosing based solely on the low-density lipoprotein cholesterol (LDL-C) levels rather than selecting a moderate- or high-intensity statin strategy based on ASCVD risk, an LDL-C ≥ 190 mg/dL, and/or the presence of diabetes as recommended in the current updated guidelines.
UTILIZING UNVERIFIED INFORMATION SOURCES
Clinicians may utilize unverified information sources. Examples ...