We've all heard the mantra of evidenced-based medicine (EBM) in the media, and perhaps in our personal lives, but what is it? How does it help me? Is the health care industry doing that now? Hopefully I can explain one of the ways that EBM has made patient care better all around: core measures and protocols based off of this research.
Core measures pertain to certain disease processes that need quick and decisive care upon arrival. These diseases need to be identified fast so appropriate and efficacious care can be given. Core measures are research-based interventions that, together, have been shown to offer solid improvement in the patients status. There are eight of them, which you can read up on at the Joint Commission site here: Joint Commission Performance Measurement Initiative.
Lets talk about how core measures shape the care given for heart attacks, also referred to as acute coronary syndrome (ACS).
The core measures are written up formally as protocols in the hospital setting and treatment is measured against that. Each hospital is rated by the joint commission on its adherence to these protocols. Here is an example of the interventions defined by Medicare: Medicare Core Measures. Here is an example of a formal, defined, written protocol from Sutter Medical Center: Sutter Medical Center ACS Core Measures.
As you can see from the protocol sheet, it is very specific in what must be done, some examples include:
- EKG done x2 with telemetry monitoring while in the hospital
- Portable Chest X-Ray
- Aspirin (usually 325 mg) on arrival, Beta Blocker on arrival,
- Lab work including Cardiac Enzymes used to test for heart attacks or high cholesterol
- Oxygen therapy
- Nitroglycerin as needed for chest pain
- Blood thinners such as heparin, lovenox, plavix, arixtra, aspirin
- Blood sugar control for diabetics
- Smoking cessation education for smokers
- Cardiac diet orders
- What prescriptions, done to the drug, dose, and frequency, that must be given on discharge
There is more to this protocol. When you come into the emergency department complaining of chest pain, quick and decisive care can be given precisely because the government paid for the research and enforces this policy. We are all safer - much safer since this research was done and effective monitoring and enforcement was put into place. Here is an example graph of mortality rates with core measure implementation at hospitals: Core Measures and 30-day mortality rates.
Please note too that this is an interdisciplinary approach to care: EKGs are done by monitor techs, unit secretaries, and respiratory therapy; x-rays are done by x-ray techs; lab work is drawn by phlebotomists and nurses with the actual analysis done by certified lab workers; respiratory provides breathing treatments, oxygen assessments, etc.; nurses and doctors implement and coordinate interventions and patient care, educate patients and families; doctors set the standards of care, care plan for each individual case, and setup up follow ups, etc.
This is a very positive thing, but sometimes can be wasteful. All chest pain is worked up as possible ACS. When you, the patient, complain of chest pain, you might mean you are having difficulty breathing, but since you stated chest pain, we have to work you up. It takes careful assessment on the part of the doctors and the nurses to make sure that we are dealing with actual chest pain and not some other symptom such as shortness of breath or heart burn.
I invite you to please go over the links I provided to the different sites and take pride in your medical system over this: we get this one absolutely right.