December 18th, 2017

Better informed consent in the ED: going through the research to practice continuum

By Daniel Cabrera, M.D.

Author: Lucas Oliveira J. e Silva (@lucasojesilva12)

Few years ago when consenting patients for procedural sedation in the Emergency Department (ED), we realized that the risks were unclear and communicating those risks to the patients was a challenge.

To solve the problem of risk communication, we knew that knowing the evidence would not be enough, however the first step would be find the best information available regarding the adverse events of procedural sedation in the ED. We looked at the literature and one study was not enough, meaning that a summary of the evidence was needed to make the large amount of information comprehensible for clinicians and patients. Two years later, we published two systematic reviews and meta-analyses (1, 2) evaluating the risks of performing procedural sedation in the ED among both the pediatric and adult populations. However, despite having summarized the literature, we found ourselves empty handed when communicating with patients. We were not filling the gap and improving the communication process, which was the main reason we spent two years working on the systematic reviews. In a 5-step framework (Figure 1) of the research to practice continuum, we were clogged in a gap between the best evidence available and good informed consent in the ED (step 4 of the framework, Figure 1).

Figure 1. 5-step framework of the research to practice continuum.

In the last few years, constant efforts have been made to put together the Evidence-Based Medicine core concepts with translation of evidence into practice, especially in terms of patient-centered perspectives (3). The need for more knowledge translation has emerged essentially from a gap between what is known from high-quality evidence and what is consistently done in clinical practice (4).

Systematic reviews offer multiple benefits but are often written in technical language, are long, and do not contain contextual details, making them hard to translate into practice (5). After the two publications, we then decided to ask for help of implementation scientists, patient education specialists, nurses, providers, caregivers, patients and professional designers, to transform the meta-analyses information into a visual aid tool (step 5 of the framework, Figure 1). An evidence-based visual aid tool was developed to help the translation of complex numbers into meaningful and straightforward information.

Here the link to the paper (open access!): link to the paper here

In this study, we described how we went through the research to practice continuum in order to better translate our research findings to the bedside. Publishing and disseminating research findings with its large amount of information are not enough within this continuum, and efforts should be made to better translate the evidence into practice. The problem of risk communication before informed consent for procedural sedation could not be solved only finding the best evidence available.

Bottom-line: The research to practice continuum in EM can go above the expectations of researchers, and efforts should be made to implement and translate the evidence into practice, taking into consideration that evidence users, including both clinicians and patients, may benefit from easy and straightforward visual aid tools for translation of research findings.

 

FULL-ARTICLE: (open access)

 

REFERENCES

  1. Bellolio MF, Gilani WI, Barrionuevo P, et al. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2016;23:119-134.
  2. Bellolio MF, Puls HA, Anderson JL, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. BMJ open. 2016;6:e011384.
  3. Lang E. Finding One's Way In Translating Evidence Into Practice. Annals of Emergency Medicine.51:791-792.
  4. Lang ES, Wyer PC, Eskin B. Executive summary: Knowledge translation in emergency medicine: establishing a research agenda and guide map for evidence uptake. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2007;14:915-918.
  5. Rowe BH, Wyer PC, Cordell WH. Evidence-based emergency medicine. Improving the dissemination of systematic reviews in emergency medicine. Annals of  Emergency Medicine. 2002 Mar;39(3):293-5.

 

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