- Email: [email protected]
Online evidence-based emergency medicine
EVIDENCE-BASED EMERGENCY MEDICINE/EDITORIAL
Online Evidence-Based Emergency Medicine William H. Cordell, MD
Online Evidence-Based Emergency Medicine
Department of Emergency Medicine Indiana University School of Medicine Indianapolis, IN Dr. Cordell is an editorial board member of Annals of Emergency Medicine. Reprints not available from the author. Address for correspondence: William H. Cordell, MD, Emergency Medicine and Trauma Center, Methodist Hospital, 1701 North Senate Boulevard, Indianapolis, IN 46202-1239; 317-962-8035, fax 317-962-2306; E-mail [email protected]. Copyright © 2002 by the American College of Emergency Physicians. 0196-0644/2002/$35.00 + 0 47/1/121485 doi:10.1067/mem.2002.121485
1 7 8
[Cordell WH. Online evidence-based emergency medicine. Ann Emerg Med. February 2002;39:178-180.] Welcome to the confluence of 2 of the most important health care innovations of the 1990s—the Internet and evidence-based medicine (EBM). Annals of Emergency Medicine and its publisher, Mosby, are pleased to introduce a special feature on the Annals Web site (www. mosby.com/AnnEmergMed) called “Online EvidenceBased Emergency Medicine.” This electronic publication is divided into 5 sections. Section I—“Principles and Skill Set of EBM” contains Annals articles that articulate the concepts and skills required to practice evidence-based emergency medical care. Section II—“Preappraised Resources” is a new feature of the evidence-based emergency medicine (EBEM) series in Annals. These are abstracts of systematic reviews pertinent to emergency medicine. This section is designed for front-line emergency clinicians who need rapid access to this relevant information. Because lack of time is an often-cited barrier to incorporating evidence and EBM into clinical practice,1 these are brief abstracts of systematic reviews that summarize evidence regarding specific clinical questions. Section III—“EBEM Instructional Reviews” contains the collection of EBEM installments that were originally designed to illustrate the application of EBM to emergency medicine. These are written as if an experienced teacher were sitting with a learner, articulating the thought process and skills of EBM. Section IV—“Links” provides electronic links to other EBM resources for patient care and clinician education. We encourage readers to send us (AnnEmergMed.EBEM@ acep.org) additional resources that they would like added to these links.
ANNALS OF EMERGENCY MEDICINE
39:2 FEBRUARY 2002
EVIDENCE-BASED EMERGENCY MEDICINE/EDITORIAL
Section V—“Feedback” is an important addition to the Annals Web page. This section is a refereed forum for readers of the EBEM series to provide feedback more rapidly than can be achieved in a paper-based journal. As a benefit of the electronic format, “Online EvidenceBased Emergency Medicine” will evolve and grow over time. We will continue to add to the information, refine its presentation, and incorporate feedback from readers. The Annals EBEM series and its companion Web site exist because of the efforts of Dr. Peter Wyer and Dr. Brian Rowe, the editors and staff of Annals, a cadre of EBM teachers and authors from the specialty of emergency medicine, and Mosby. Dr. Wyer and I first sketched the vision for the EBEM series in 1996 over chicory coffee and beignets at Café du Monde in New Orleans. Having both just returned from the Evidence-Based Clinical Practice Workshop at McMaster University in Hamilton, Ontario, Canada, we envisioned a series of articles that would illustrate how EBM principles could be applied to emergency medicine. Dr. Wyer subsequently joined Dr. Rowe and Dr. Steven Lloyd as faculty at the annual McMaster course, where they established the first dedicated EBM workshops for emergency physicians. Dr. Wyer is an internationally respected teacher of EBM and a contributor to the justreleased EBM textbook Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice.2 He continues to serve as a consulting editor for the Annals EBEM series. In 1998, Dr. Rowe, from the University of Alberta, Edmonton, Alberta, Canada, joined the Annals editorial board and the EBEM effort. Dr. Rowe has served as a contributor to the Cochrane Collaboration, which many regard as the “Human Genome Project of clinical trials.” Trained at McMaster University (“ground zero” for EBM in North America), he brings the discipline of systematic reviews to our specialty. He currently holds the appointment of Canada Research Council Chair of Emergency Airway Diseases and is responsible for the “Preappraised Resources” section of this online effort. The EBEM concept resonated with Dr. Joseph F. Waeckerle, editor in chief of Annals, and other members of the editorial board who viewed the series as a bridge between the scientific articles and clinical articles. Although Annals has always been a platform for publishing peer-reviewed scientific papers, the editors have encouraged accessibility of information for those frontline, nonacademic clinicians who will use research published in the journal in their daily practice.
FEBRUARY 2002
39:2
ANNALS OF EMERGENCY MEDICINE
As a researcher colleague remarked, “This is perhaps the greatest time in history for therapeutics and diagnostics research. We are witnessing the confluence of genomics, proteomics, and information technology.” I would argue that it is similarly a transformative time for clinical care. We are witnessing the confluence of innovations in information technology and how we conceptualize, learn, teach, and practice clinical decisionmaking. Two innovations, in particular, epitomize these changes: the Internet and EBM. The Internet will allow information to be presented where it matters most in clinical decisionmaking—at the point-of-care—when and where decisions about patients are being made (Figure). Providing information and feedback through electronic information systems to physicians at the time they are making decisions has been shown to be an effective way of changing clinical behavior and influencing clinical decisionmaking.3,4 Emergency clinicians are among the most information-intensive health care specialists.5 They require immediate access to information to care for a wide spectrum of patients 24 hours a day on an unscheduled basis. EBM is a philosophy and skill set for integrating research evidence, clinician experience, and a consideration of values, preferences, and rights for clinical decisionmaking. EBM is also transforming how clinicians are educated and learn for the rest of their lives. The Annals “Online Evidence-Based Emergency Medicine” Web site thus represents the convergence of on-demand information technology and EBM. As the Figure illustrates, these converging trends will be important steps for improving
Figure.
Converging trends in clinical decisionmaking. Scientific evidence
Clinician experience
Point-of-care “on demand” “just-in-time” Information for decisionmaking
Ethics and values
Information technologies
1 7 9
EVIDENCE-BASED EMERGENCY MEDICINE/EDITORIAL
clinical decisionmaking where it matters most—at the point-of-care—and for whom it matters most—patients. 1. McColl A, Smith H, White P, et al. General practitioner’s perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998;316:361-365. 2. Guyatt G, Drummond R. Users’ Guides to the Medical Literature: A Manual for EvidenceBased Clinical Practice. Chicago, IL: AMA Press; 2002. 3. Tierney WM, Miller ME, Overhage JM, et al. Physician inpatient order writing on microcomputer workstations: effects on resource utilization. JAMA. 1993;269:379-383. 4. Wong ET, Abendroth TW. Reaping the benefits of medical information systems. Acad Med. 1996;71:353-357. 5. Cordell WH, Overhage JM, Waeckerle JF. Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. The Information Management Work Group. Ann Emerg Med. 1998;31:172-178. Acad Emerg Med. 1998;5:162-167.
1 8 0
ANNALS OF EMERGENCY MEDICINE
39:2 FEBRUARY 2002
Online Evidence-Based Emergency Medicine William H. Cordell, MD
Online Evidence-Based Emergency Medicine
Department of Emergency Medicine Indiana University School of Medicine Indianapolis, IN Dr. Cordell is an editorial board member of Annals of Emergency Medicine. Reprints not available from the author. Address for correspondence: William H. Cordell, MD, Emergency Medicine and Trauma Center, Methodist Hospital, 1701 North Senate Boulevard, Indianapolis, IN 46202-1239; 317-962-8035, fax 317-962-2306; E-mail [email protected]. Copyright © 2002 by the American College of Emergency Physicians. 0196-0644/2002/$35.00 + 0 47/1/121485 doi:10.1067/mem.2002.121485
1 7 8
[Cordell WH. Online evidence-based emergency medicine. Ann Emerg Med. February 2002;39:178-180.] Welcome to the confluence of 2 of the most important health care innovations of the 1990s—the Internet and evidence-based medicine (EBM). Annals of Emergency Medicine and its publisher, Mosby, are pleased to introduce a special feature on the Annals Web site (www. mosby.com/AnnEmergMed) called “Online EvidenceBased Emergency Medicine.” This electronic publication is divided into 5 sections. Section I—“Principles and Skill Set of EBM” contains Annals articles that articulate the concepts and skills required to practice evidence-based emergency medical care. Section II—“Preappraised Resources” is a new feature of the evidence-based emergency medicine (EBEM) series in Annals. These are abstracts of systematic reviews pertinent to emergency medicine. This section is designed for front-line emergency clinicians who need rapid access to this relevant information. Because lack of time is an often-cited barrier to incorporating evidence and EBM into clinical practice,1 these are brief abstracts of systematic reviews that summarize evidence regarding specific clinical questions. Section III—“EBEM Instructional Reviews” contains the collection of EBEM installments that were originally designed to illustrate the application of EBM to emergency medicine. These are written as if an experienced teacher were sitting with a learner, articulating the thought process and skills of EBM. Section IV—“Links” provides electronic links to other EBM resources for patient care and clinician education. We encourage readers to send us (AnnEmergMed.EBEM@ acep.org) additional resources that they would like added to these links.
ANNALS OF EMERGENCY MEDICINE
39:2 FEBRUARY 2002
EVIDENCE-BASED EMERGENCY MEDICINE/EDITORIAL
Section V—“Feedback” is an important addition to the Annals Web page. This section is a refereed forum for readers of the EBEM series to provide feedback more rapidly than can be achieved in a paper-based journal. As a benefit of the electronic format, “Online EvidenceBased Emergency Medicine” will evolve and grow over time. We will continue to add to the information, refine its presentation, and incorporate feedback from readers. The Annals EBEM series and its companion Web site exist because of the efforts of Dr. Peter Wyer and Dr. Brian Rowe, the editors and staff of Annals, a cadre of EBM teachers and authors from the specialty of emergency medicine, and Mosby. Dr. Wyer and I first sketched the vision for the EBEM series in 1996 over chicory coffee and beignets at Café du Monde in New Orleans. Having both just returned from the Evidence-Based Clinical Practice Workshop at McMaster University in Hamilton, Ontario, Canada, we envisioned a series of articles that would illustrate how EBM principles could be applied to emergency medicine. Dr. Wyer subsequently joined Dr. Rowe and Dr. Steven Lloyd as faculty at the annual McMaster course, where they established the first dedicated EBM workshops for emergency physicians. Dr. Wyer is an internationally respected teacher of EBM and a contributor to the justreleased EBM textbook Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice.2 He continues to serve as a consulting editor for the Annals EBEM series. In 1998, Dr. Rowe, from the University of Alberta, Edmonton, Alberta, Canada, joined the Annals editorial board and the EBEM effort. Dr. Rowe has served as a contributor to the Cochrane Collaboration, which many regard as the “Human Genome Project of clinical trials.” Trained at McMaster University (“ground zero” for EBM in North America), he brings the discipline of systematic reviews to our specialty. He currently holds the appointment of Canada Research Council Chair of Emergency Airway Diseases and is responsible for the “Preappraised Resources” section of this online effort. The EBEM concept resonated with Dr. Joseph F. Waeckerle, editor in chief of Annals, and other members of the editorial board who viewed the series as a bridge between the scientific articles and clinical articles. Although Annals has always been a platform for publishing peer-reviewed scientific papers, the editors have encouraged accessibility of information for those frontline, nonacademic clinicians who will use research published in the journal in their daily practice.
FEBRUARY 2002
39:2
ANNALS OF EMERGENCY MEDICINE
As a researcher colleague remarked, “This is perhaps the greatest time in history for therapeutics and diagnostics research. We are witnessing the confluence of genomics, proteomics, and information technology.” I would argue that it is similarly a transformative time for clinical care. We are witnessing the confluence of innovations in information technology and how we conceptualize, learn, teach, and practice clinical decisionmaking. Two innovations, in particular, epitomize these changes: the Internet and EBM. The Internet will allow information to be presented where it matters most in clinical decisionmaking—at the point-of-care—when and where decisions about patients are being made (Figure). Providing information and feedback through electronic information systems to physicians at the time they are making decisions has been shown to be an effective way of changing clinical behavior and influencing clinical decisionmaking.3,4 Emergency clinicians are among the most information-intensive health care specialists.5 They require immediate access to information to care for a wide spectrum of patients 24 hours a day on an unscheduled basis. EBM is a philosophy and skill set for integrating research evidence, clinician experience, and a consideration of values, preferences, and rights for clinical decisionmaking. EBM is also transforming how clinicians are educated and learn for the rest of their lives. The Annals “Online Evidence-Based Emergency Medicine” Web site thus represents the convergence of on-demand information technology and EBM. As the Figure illustrates, these converging trends will be important steps for improving
Figure.
Converging trends in clinical decisionmaking. Scientific evidence
Clinician experience
Point-of-care “on demand” “just-in-time” Information for decisionmaking
Ethics and values
Information technologies
1 7 9
EVIDENCE-BASED EMERGENCY MEDICINE/EDITORIAL
clinical decisionmaking where it matters most—at the point-of-care—and for whom it matters most—patients. 1. McColl A, Smith H, White P, et al. General practitioner’s perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998;316:361-365. 2. Guyatt G, Drummond R. Users’ Guides to the Medical Literature: A Manual for EvidenceBased Clinical Practice. Chicago, IL: AMA Press; 2002. 3. Tierney WM, Miller ME, Overhage JM, et al. Physician inpatient order writing on microcomputer workstations: effects on resource utilization. JAMA. 1993;269:379-383. 4. Wong ET, Abendroth TW. Reaping the benefits of medical information systems. Acad Med. 1996;71:353-357. 5. Cordell WH, Overhage JM, Waeckerle JF. Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. The Information Management Work Group. Ann Emerg Med. 1998;31:172-178. Acad Emerg Med. 1998;5:162-167.
1 8 0
ANNALS OF EMERGENCY MEDICINE
39:2 FEBRUARY 2002