Step-by-Step Medicine

Evidence-based practice guidelines are key tools to help hospitalists practice high-quality medicine and demonstrate the value of their inpatient care model. Guidelines are designed to produce superior care outcomes and resource utilization efficiencies by encouraging proven medical practices and discouraging ineffective or unproven ones. Yet inefficiencies, variation, and quality gaps persist in medical care—much to the chagrin of policymakers.

Is the answer more guidelines, and better implementation of existing ones?

Research experts and many HM leaders say yes.

In fact, HM is leading the way in an important new area for which there is little uniform guidance: optimal care transitions during patient handoffs. Care transitions are a pivotal time in the patient care process and are replete with avoidable service duplication, poor communication among providers, gaps in care reconciliation, and patient-safety issues.

SHM has joined five other organizations in issuing a Transitions of Care Consensus Policy Statement, which promises more systematic, safe, and efficient patient handoffs.1 SHM also is targeting care-transition improvement in a variety of other venues, all of which can help hospitalists demonstrate more persuasively the value they bring to healthcare delivery.

Guidelines Work

Practice guidelines work, in the sense that they help providers practice in ways consistent with what the best aggregate knowledge and expert opinion says is most effective. The evidence allows physicians to avoid expending scarce resources on ineffective clinical services. Their importance is magnified by the current urgency given to value-based purchasing in healthcare reform. “The right care, for the right patient, at the right time” is the new mantra of payors and policymakers, many of whom are demanding the best and most efficient healthcare delivery at the lowest cost.

Roberta Fruth, PhD, RN, FAAN, JCR/JCIListen to Roberta Fruth, PhD, RN, FAAN, JCR/JCI, senior consultant for Joint Commission Resources, and Janet Corrigan, PhD, MBA, president and CEO of the National Quality Forum, discuss evidence-based practice guidelines.

“When providers are not providing the right care at the right time to patients, we find that the patient often gets more services … that they didn’t need. That oftentimes exposes them to potential harm and (services) that are wasteful of resources,” says Janet M. Corrigan, PhD, MBA, president and CEO of the National Quality Forum (NQF), a standard-setting organization that convenes national experts to apply “gold standard” endorsement of guidelines developed by professional medical societies and other entities. “Guidelines are a way of synthesizing evidence and translating it into action steps that providers can follow so that they get the best results that we know how to get for their patients.”

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