Emergency Health Services Translating Research Into Practice Andrew Travers MD MSc FRCPC Staff Physician, QE-II Emergency Provincial Medical Director Emergency Health Services Halifax, Nova Scotia

Conflict of Interest No reported financial conflicts of interests to declare. No reported financial conflicts of interests to declare. Contributing Author Contributing Author –Cochrane Collaboration l Airway Review Group –International Liaison Committee on Resuscitation E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Acknowledgements Dave Petrie MD Dave Petrie MD Ed Cain MD Ed Cain MD Jan Jensen ACP Jan Jensen ACP Dave Urquhart Dave Urquhart Corinne Burke Corinne Burke Dalhousie Division of EMS Dalhousie University E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Out-of-Hospital Medicine Prehospital Medicine Paramedicine Evidence-Based Medicine EBP, EBID, EBG, etc. E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

What on *&^%$# earth is ‘knowledge translation’? E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e Jay Walker 0100 Sept

Knowledge Translation Knowledge Translation (KT) is a method by which all healthcare stakeholders can bridge the gaps that exist between current knowledge / evidence and current practice. Knowledge Translation (KT) is a method by which all healthcare stakeholders can bridge the gaps that exist between current knowledge / evidence and current practice. For each stakeholder there are different gaps. For each stakeholder there are different gaps. E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Knowledge Translation W 5 HO W5W5 H O E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Who What How When Why Where Observe E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Knowledge Translation - Proposal to Practice - Who (is the audience?) Who (is the audience?) What (is the message?) What (is the message?) When (is the best time?) When (is the best time?) Where (is the best place?) Where (is the best place?) Why (is the message important?) Why (is the message important?) How (to convey the message?) How (to convey the message?) Observe (the effect of the message.) Observe (the effect of the message.) W 5 HO E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

CPR Knowledge Translation Communication Implementation System-Wide Anticipation New Guidelines Optimization Collaboration Multidisciplinary Integration Processes of Care E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Objectives described. Clinical questions described. Application to patients described. Target users defined. Piloted among users. Specific & unambiguous. Different Mx options considered. Systematic searches. Clear selection criteria. Clear procedure for Updating. Scope & Purpose Applicability Rigour of Development Clarity & Presentation Stakeholder Involvement Editorial Independence Completed

Includes individuals from relevant groups. Editorial independent from funding. Conflicts of interest recorded. Key recommendations easily identifiable. Application support tools. Formulation methods clearly described. Explicit link between evidence & recommendation. Expert external review. Scope & Purpose Applicability Rigour of Development Clarity & Presentation Stakeholder Involvement Editorial Independence Weaknesses Key review criteria for monitoring and auditing.

PEP: Other Weaknesses Minimal peer review & auditing. Minimal peer review & auditing. Ensuring that protocols remain up to date. Ensuring that protocols remain up to date. Minimal funding of infrastructure. Minimal funding of infrastructure. Lack of publications from the EBP3O initiative. Lack of publications from the EBP3O initiative. A contemporary and generalizable method of ‘grading’ evidence is lacking. A contemporary and generalizable method of ‘grading’ evidence is lacking. E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Patient preferences and views sought. Discussion of organisational barriers. Application costs considered. Consideration of side effects, benefits, risks. Scope & Purpose Applicability Rigour of Development Clarity & Presentation Stakeholder Involvement Editorial Independence Future Development E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

PEP: Other Future Directions Creation and linkage of ‘online’ and ‘didactic’ basic and advanced EBP course for paramedics with input into the EB3P0. Creation and linkage of ‘online’ and ‘didactic’ basic and advanced EBP course for paramedics with input into the EB3P0. ‘Evidence mapping’. ‘Evidence mapping’. Linkage of protocol compliance/performance with evidence evaluation process. Linkage of protocol compliance/performance with evidence evaluation process. Integration/adaptation into ILCOR, Cochrane, etc. Integration/adaptation into ILCOR, Cochrane, etc. –Movement of paramedics into these domains. E H S t r a n s l a t i n g r e s e a r c h i n t o p r a c t i c e

Closing Remarks Include paramedics early – “content experts”. A collaborative, community based model is feasible. Address the needs/input of the end-user(s). Catalogue prehospital guidelines and share them. Standardised/adaptable prehospital ‘grading’. Optimize evidence search & appraisal process.