Clinical decision support for better quality care
Professor Sheona Macleod, Interim Medical Director, Health Education England
Dr Kieran Walsh, Clinical Director, BMJ
BMJ Best Practice is the clinical decision support tool of BMJ. It offers continually updated, evidence-based and practical content that helps doctors and other healthcare professionals make better clinical decisions.
This is the first of a series of blogs on clinical decision support, healthcare professional education, and BMJ Best Practice by Sheona Macleod and Kieran Walsh. This first blog concentrates on the latest thinking on evidence-based medicine, accessing medical knowledge and interprofessional learning.
BMJ Best Practice is freely available to all healthcare professionals who work for the NHS in England as a result of a national subscription from Health Education England. The purpose of this provision is to ensure that continually updated and evidence-based medical knowledge is constantly in the hands of healthcare staff.
Having medical knowledge that is continually updated is vital.
In the past, doctors and other healthcare professionals learned from textbooks, but the world has moved on a great deal since then. Medical knowledge is changing rapidly, and people need to know that they are accessing the best and the most current evidence when making decisions. Doctors have always wanted to practice using the scientific evidence base, but this is a challenge in the modern era. Often there is a concern that the tsunami of new scientific knowledge means that it is hard to keep updated – the advantage of online clinical decision support is that it can incorporate new evidence within days and so give healthcare professionals confidence that they are practising according to the latest guidelines and that their practice is safe.
Evidence-based medicine is another cornerstone of clinical decision support generally and BMJ Best Practice specifically. In the past, healthcare professionals had time to read all the relevant information and analyse it – however this is now impossible. Current thinking is that it is better to have all the evidence summarised and synthesised and therefore immediately accessible without interruption to the clinical workflow. If healthcare professionals are trying to make a decision with a patient on the ward or in the clinic, they simply don’t have time to look at original research studies. So the need from users is for someone else do that work so healthcare professionals know that they are looking at evidence-based knowledge from trusted experts who have analysed the information, pulled it together, and extracted the key points. That is becoming the gold standard in evidence-based medicine and clinical decision support and is what BMJ Best Practice provides.
Another key component of evidence-based medicine and clinical decision support is access.
Healthcare professionals want and need evidence-based answers quickly - on whatever device they are using – be it a desktop, laptop or mobile. They also need content online and offline via an app. What healthcare professionals mean by speed of access is that they want answers within seconds. This is challenging to creators of clinical decision support – but it is a consistent theme in user-testing of BMJ Best Practice. The ultimate goal is to enable users to look something up on their phone and find an answer to their question immediately. This fits with the strategy of supporting healthcare professionals in making good decisions and delivering the best possible patient care at the point of need. One of the main drivers of this strategy is pressure in clinical settings. Staff worry that they can only concentrate for a brief period of time on a patient and then have to rush off and do other things. That increases the pressure on doctors to make an immediate decision - they haven't got the time to mull things over or to go and ask people; they need an answer instantly. The pressure in the hospital environment also makes it impractical to have to go and look it up on a computer elsewhere. Healthcare professionals need decision support in their hands, now. This will give them more time which they can then in turn give back to the patient.
Thus, clinical decision support should enable more patient centred care.
It should allow healthcare professionals to do the best they can and have the time to focus on the patient. If healthcare professionals have a good knowledge base and so confidence in their decisions, it allows them to be the confident and compassionate professionals that patients need. There is always anxiety for doctors starting in hospital about whether they “will know everything” and of course remembering everything is simply not feasible. So knowing that you have a way that you can look things up and get the right answer is really important, especially for juniors, who are continuously moving between posts. It is vital that juniors know that as they move to another clinical environment, they still have the support of BMJ Best Practice and Health Education England. Foundation doctors are moving every four months and core trainees are also moving regularly - so enabling this access is really about putting the rhetoric of support from up high into reality on the ground.
Of course clinical decision support is about more than just junior doctors.
Senior clinicians need to check things that are outside of their specialist knowledge; GPs need to have access to the widest possible knowledge base; and pharmacists and nurse practitioners also find it helpful. Interprofessional team working is of growing importance in the NHS and it makes a great deal of sense for all healthcare professionals to have access to the same resource. This results in interprofessional team members using the same language and feeling that they can work well together and also having confidence in each other’s knowledge. Having a tool that all members of the team can access will help build trust and rapport in interprofessional team working. Learning together is essential to working together, and shared clinical decision support is a vital enabler of this learning.
Funded by Health Education England, BMJ Best Practice is free to all NHS staff.
KW works for BMJ which produces BMJ Best Practice.