Evidence based medicine incorporates the best research evidence with clinician knowledge and patient's values and preferences. However healthcare providers often fall short. ‘Bridging the quality chasm’ the 2001 report from the US Institute of Medicine (IOM), highlighted the issues of “overuse, underuse, and misuse” in healthcare [
]. Of these, the evidence-practice gaps of “underuse” and “overuse” are likely to be substantial contributors to the preventable burden of harm from poor quality of care [
- Institute of Medicine
Crossing the quality chasm: a new health system for the 21st century.
Washington Institute of Medicine, 2001
]. Sometimes the gap is due to a failure of implementation. There are numerous examples where research evidence of benefit has taken years to be adopted in practice (e.g. crystalloid fluids for shock management). However, most care is delivered as a bundle where multiple processes all synergistically work towards patient outcomes. A study by Rayan et al. of 774 randomly selected patients with moderate to severe injuries admitted to US level one trauma centres, found only 53% of patients who met recognized clinical criteria received common trauma-specific processes of care [
- Glasziou P.
- Haynes B.
The paths from research to improved health outcomes.
Evid Based Med. 2005; 10: 4-7
]. Using similar methodology, Shafi et al. found that after adjusting for potential confounders patients who received all recommended care were 58% less likely to die (OR 0.42; 95% CI, 0.28–0.62) than those who did not [
- Rayan N.
- Barnes S.
- Flemming N.
- Kudyakov R.
- Ballard D.
- Gentilello L.M.
- et al.
Barriers to compliance with evidence-based care in trauma.
J Trauma Acute Care Surg. 2012; 72: 585-593
- Shafi S.
- Barnes S.
- Rayan N.
- Kudyakov R.
- Foreman M.
- Cryer H.G.
- et al.
Compliance with recommended care at trauma centers: association with patient outcomes.
J Am Coll Surg. 2014; 219: 189-198
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