Evidence-based practice (EBP) is of crucial importance for improving the quality of health care services and the patients’ outcomes. The health care practitioners should use only the most accurate information for choosing appropriate intervention measures and developing effective health care plans.
The EBP is one of key elements of the professional accountability of the medical workers. The effective use of the health care resources requires integrating theoretical knowledge and best available evidence, adapting it to the peculiarities of a particular case and realities of the clinical setting. The five critical steps of the EBP include translation of the information needs into an answerable clinical question, search of the best available evidence for covering the issue, critical evaluation of this evidence, integration of the evidence, patient’s needs and theoretical knowledge, and evaluation of the effectiveness of the performance.
Formulating a searchable and answerable question, a health care practitioner should consider the type of the definition that can be related to intervention, diagnosis, prognosis or patients’ experiences. The diagnosis questions are aimed at choosing the most effective testing procedures for detecting the first symptoms of diseases at their early stages. For example, the question of effectiveness of implementation of the chest pain unit (CPU) approach for predicting the cardiac intervention is an example of a diagnosis formulation. Goodacre et al (2005) noted that “The chest pain unit (CPU) provides rapid diagnostic assessment for patients with acute, undifferentiated chest pain, using a combination of electrocardiographic (ECG) recording, biochemical markers and provocative cardiac testing” (Which diagnostic tests are most useful).
Early diagnosis is of crucial importance for effective intervention of all diseases. Regarding the ACS, the consequences of the wrong diagnosis and the premature discharge of the patient with undetected cardiac symptoms can be tragic. Quin (2000) noted that “between 2% and 5% of patients with acute myocardial infarctions are discharged from the ED, and 20% of malpractice claims against emergency physicians relate to the management of acute coronary syndrome” (p. 403).
Considering this statistics data, the effective measures need to be imposed for overcoming the limitations of diagnostic tests and effective use of resources for the purpose of improving the quality of health care services and decreasing the physicians’ risk. Besides, transferring the undifferentiated patients’ population with chest pain to the CPUs would allow the staff to use the available resources more effectively for satisfying the needs of other clients.
Evaluation of the effectiveness of patients’ admission to CPU is significant for improving the quality of health care services. Diagnosing patients with possible acute coronary syndrome (ACS) presupposes a number of difficulties. With the insufficiency of hospital resources for rapid evaluation and treatment of patients with possible ACS, their admission to specialized CPUs can be beneficial for cutting costs and ensuring appropriate risk assessment procedures and intervention programs.
A CPU approach will result in more effective use of the health care resources. Undifferentiated patient population with symptoms of chest discomfort requires a systematic approach, well-trained staff and specific resources. Instead of admission of these patients to hospital for further monitoring of their symptoms that can be consistent with ACS, strict protocols and serial diagnostic testing used at CPUs are advantageous for improving the patients’ outcomes and enhancing the effectiveness of work of the clinical settings.
Blomkalns and Gibler (2005) noted that “the evaluation of patients who exhibit symptoms consistent with ACS requires a protocol that includes testing for myocardial necrosis, rest ischemia, and exercise-induced ischemia” (p. 411). Though CPUs are often criticized for their narrow specialization and inability to detect the non-cardiac causes of chest discomfort, excluding the cardiac symptoms is important for planning the future monitoring and intervention.
The next step after evaluating the needs for effective use of CPUs is translation them into a searchable and answerable question in the frames of the EBP approach. The PICO format is helpful for formulating the problem and simplifying the following research process. Detecting the patient, intervention, control and outcome as the main components of the PICO formula is important during the first step of the EBP.
The age, gender and condition characteristics need to be taken into consideration for defining the target patients’ population. Regarding the CPU problem, the symptoms of chest discomfort are significant, while the age and gender criteria are less important. As to intervention as the central part of the PICO format, these are serial testing at a CPU that need to be mentioned in the question. The chosen intervention is to be compared to another model or no treatment at all. The monitoring of patients in a traditional hospital setting is an example of a control model. Considering the type of the chosen question, the outcome of the research is the early and correct diagnosis. Summing up all the above mentioned criteria, the formulation of the clinical question in the PICO format is:
- In patients with symptoms that can be consistent with ACS
- how does diagnostic testing at a CPU
- compared with inpatient admission
- effect diagnosis.
Reference List
Blomkalns, A. & Gibler, W. (2005). Chest pain unit concept: Rationale and diagnostic strategies. Cardiology Clinics, 23: 411-421. Web.
Goodacre, S. et al. (2005). Which diagnostic tests are most useful in a chest pain unit protocol? BMC Emergency Medicine, 5 (6). Web.
Quin, G. (2000). Chest pain evaluation units. Western Journal of Medicine, 173(6): 403-407.