[MUSIC] In this video, we're going to talk about a practical framework for translating evidence into practice. This is an especially important concept for many hospitals. And this would be an appropriate approach any time that you have current evidence-based recommendations for therapies that the patient should receive, and then begin to translate that into best practice at the bedside. This is an exceedingly important concept for many healthcare providers and healthcare organizations, to begin to ensure that patients are receiving the evidence-based therapies they should. So, how often are patients receiving the evidence-based therapies they should? Well, this is a really important study published a number of years ago, where these authors looked at 30 nationally accepted quality indicators. These are diseases where patients suffer significant morbidity, mortality. And in addition, these diseases represent a significant burden on our healthcare system. And on average, these authors found that patients received the therapies they should only about 55% of the time. For healthcare organizations, this is becoming exceedingly important, because we all are focusing on improving care for our in-hospital patient population, as well as focusing on reducing unnecessary variation in care. All emphasize the importance of ensuring that patients receive the evidence-based therapies they should. Well, on a more personal note, though, I think that this is exceedingly important for health care providers, as well. Because if you really think about it, who are these patients in this study? Well, unfortunately, they're us, right? They're our family members, they're our loved ones, and they're our communities. And essentially, the way that this system is set up right now is that, if our patients were to present the healthcare with any of these chronic diseases, then, unfortunately, the chances of patients getting the therapies they should is not much better than a flip of the coin. Now, there have been a number of approaches over the years that have focused on translating evidence into practice, or helping to ensure that patients receive the evidence-based therapies they should. I suspect you'll recognize many of these, from the evidence-based medicine movement, to recertification and continuing medical education requirements for our physicians and our nurses. Feedback and accountability, public reporting and pay for performance, are becoming increasingly focused. And then more recent strategies, including patient centered care, are all strategies that have strived towards ensuring that patients receive the evidence-based therapies they should. What these authors demonstrated was that individual strategies are probably not anywhere near as effective as combining these strategies to create multifaceted interventions. But we also recognize that many of these strategies focusing on individual providers, like physicians at the bedside, don't begin to address the much larger issues and other important stakeholders within our organizations that can impact the likelihood that patients receive the evidence-based therapies they should. To begin to address some of these issues, researchers at Hopkins and the Armstrong Institute, many years ago now, have put together this model for translating evidence into practice. This model combines the successful attributes of prior studies, and begins to frame this in a practical way that could help organizations begin to manage that change process, and to ensure that patients receive the evidence-based therapies they should. This model for translating evidence into practice has a number of steps, and in future videos, we'll be talking about each of these steps in much more detail. We've used this model now successfully in a number of large scale collaboratives, working with thousands of hospitals across the US and around the country. For example, applying this model towards a prevention of healthcare associated infections, including central line associated blood stream infections, has been exceedingly effective. In a statewide effort called the Michigan Keystone ICU Program, implementation of this TRIP model was associated with a dramatic reduction in central line associated blood stream infections in more than a hundred ICUs, predominantly in the state of Michigan. We then went on to conduct and work with hospitals around the country. Over a thousand hospitals participated in a national effort, and implementation of this translating evidence into practice model resulted in a 40% reduction in blood stream infections, truly a pretty significant result. We also applied this model to prevent another healthcare associated infection, ventilator associated pneumonias. These complications associated with mechanical ventilation, or patients on mechanical ventilation, are associated with significant morbidity and mortality. Ventilator associated pneumonia is thought to be among the most common and most lethal healthcare associated infections that occur in the in-hospital patient setting. Translation of evidence into practice, or applying this model, was associated with dramatic reductions in ventilator associated pneumonia in over 100 ICUs. We've also been exploring how this model applies within our own healthcare organization, for the prevention of venous thromboembolism, a potentially lethal complication that occurs in hospitalized patients, as well as for the prevention of surgical site infections amongst patients undergoing colorectal surgery at Johns Hopkins. In the next video, we'll be talking much more in detail about each of these steps within the model for translating evidence into practice.
