Clinical governance, EBM Flashcards
Describe what clinical governance is:
Activities (7) that Drs practice
improve + maintain best practice
ensures NHS is accountable to public
7 pillars of clinical governance:
CARE Clinical effectiveness: EBM Audit: Risk management: Education and training: own and others Patient and public involvement, IT, staff management
What does Risk management involve
follow protocol,
reflect mistakes,
report serious events
Lessons learnt, improve protocol, falls meeting
Root cause analysis =
investigation into causes of untoward incident
Who in your trust is responsible for clinical governance?
Legal responsibility:
– Chief exec
Practical responsibility:
– Trust board, Medical/nursing/clinical directors, all staff
Difference between a standard, guidelin and protocoel
Standard: -- defined level of quality that must be achieved Guidelines: -- recommendation for clinical practice based on EBM Protocol: -- step by step approach -- management of situation -- Should be followed as cf guideline
What is EBM:
Combination of:
Best research evidence and clinical expertise
Applied to patient’s values
Steps in EBM
Patient question
Doctor develops clinical question
Systematic review using PICO
Analyse relevant evidence
Integrate evidence with clinical practice
Inform patient: work with patients values
PICO
(population, intervention, comparison, outcome)
Example of EBM:
Poster prize for EBM: comp of FNOF
- Systematic review: evidence
- Common + serious complications,
- Split into pre/peri-op, short and long term.
- Incidence stated with clinical significance.
- Level of evidence
What are the different lvels f evidence
1a systematic review/ meta-analysis 1b randomised controlled trial 2a cotrolled study w/o randomisation 2b quasi-experimental - cohort study 3 case controlled studies, case series 4 expert opinion
Importance of clinical expertise in EBM
EBM
– can inform but never replace
Eg different age, ethnicity, com-morbidity etc
– Risk vs benefit
