Evidence-based medicine (EBM) is a useful set of principles and tools that can help improve patient care. Unfortunately, there is little that is sexy and dramatic about EBM. Science in general tries to avoid the grandiose generalities that make for good marketing, and EBM in particular tries to focus on narrow, well-defined questions and answers that are constrained by the available evidence. This makes the impact of EBM methods less clear and dramatic, though no less real.
One example of a simple, inexpensive practice that is supported by good evidence and has real impact on patient well-being, but which nevertheless seems dull when talked about, it pre-surgical checklists. In his book The Checklist Manifesto, surgeon Atul Gawande eloquently argued that the simple process of having a formal, explicit checklist of procedures to g o through before, during, and after surgery would reduce medical errors. And despite the scoffing of many surgeons, who felt they were too smart and educated to need anything so obvious as a checklist to prevent their mistakes, the evidence has accumulated that the use of such checklists reduces errors, cost, injuries, and deaths.
Sadly, evidence for even such simple, low-cost interventions is often hard to come by in veterinary medicine. However, a recent study has now provided some data supporting the use of surgical checklists in the care of veterinary patients.
Bergström, A., Dimopoulou, M. and Eldh, M. (2016), Reduction of Surgical Complications in Dogs and Cats by the Use of a Surgical Safety Checklist. Veterinary Surgery, 45: 571–576.
The study involved assessing the rate and severity of surgical complications in 300 dogs and cats undergoing surgery prior to the introduction of a surgical checklist. The checklist was then put in use, and the next 220 surgical patients were also evaluated for complications. The comparison showed quite clearly that, “The frequency and severity of postoperative complications was significantly decreased after introduction of a surgical checklist.”
This is the sort of simple, inexpensive tool that can be put into use and which, over the many thousands of surgeries done on veterinary patients every year, can have a dramatic effect on the welfare of patients. While it may not be as dramatic as announcing a “revolutionary breakthrough” in disease treatment, it is the kind of tangible improvement in medical care brought about by science and evidence-based medicine.