Implementing EBM

[EpiEMS]

How much training and/or education do you have in interpreting evidence-based medicine, and the medical literature generally?

Any successes in prehospital folks implementing new EBM? For example, perhaps you were able to convince your medical director to abandon LSB immobilization in the protocol-monkey style?

On another note, how much did your EMT, AEMT, or paramedic course cover reading, understanding, and implementing EBM? Mine had a brief mention, but not much on the implementation side, understandably. What should an EMT, AEMT, or medic curriculum cover in the way of EBM?

Myself, no successes in implementation, despite a good knowledge of stats (admittedly, I'm not a PhD in any sort of quantitative discipline or anything). It's tough to explain studies and evidence to medics and EMTs (and physicians, PAs, and RNs) who have limited knowledge of epidemiological principles and statistics, on top of little faculty with numbers.

 

[mycrofft]

It's a matter of politics, and leaving enough copies of a journal lying around the Dr's lounge and restroom open to the right article

 

[NomadicMedic]

My paramedic program offered a course as part of the degree program called "Contemporary Issues in Pre-hospital Care".

This is a dynamic course that focuses on the various components of quality EMS. The course is a seminar style course that utilizes assorted current readings in conjunction with small group work that promotes critical thinking and a global understanding of what comprises state of the art out-of-hospital care.

In otherwords, a study of EBM. A decent course. I enjoyed it.

 

[mycrofft]

I think I'm missing something. URLs anyone?

Without background, sounds like field folks trying to change protocols by producing literature to support their argument. If that's it, without leverage,. the boss will say "Use the established suggestion channels, now get back to work you adorable knuckleheads".

 

[VFlutter]

What specifically are you trying to implement? There are a lot of factors that go into a policy change decision and unfortunately clinical evidence is not always the biggest factor. You have to look at the training, cost, liability, etc that goes into it. It may be the best medically but not practically.

Maybe try looking at other departments that have made a similar change and looking at their entire process.

For example, a hospital in our area was having an increase in central line associated bloodstream infections. Some of the staff went through an analysis of what could be causing the problem and dug through EBM literature and decide to change how and when they did central line dressing changes. This required a formal proposal and a long process of evaluation. After that they had to do an inservice for all the ICU RNs to explain the changes. Eventually the changes were implemented and infection rates went down.

Long story short even something relatively simple like that required lots of effort, money, and time before things changed.