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EDUCATIONAL SOUNDBITES: Conference Series on Clinical Practice Variations

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Title: EDUCATIONAL SOUNDBITES: Conference Series on Clinical Practice Variations


1
EDUCATIONAL SOUNDBITES Conference Series on
Clinical Practice Variations
  • Michele L. Dorfsman, MD
  • Allan B. Wolfson, MD
  • Department of Emergency Medicine
  • University of Pittsburgh School of Medicine
  • UPMC

2
Background
  • Individual variations in clinical practice exist
    in training programs, even within the same
    hospital or group
  • Trainees trying to develop their own practice
    style can find this variation frustrating or
    confusing
  • Faculty members may not even know how much
    clinical practice variation exists until these
    issues are brought up for discussion

3
Objectives
  • Address individual variations in clinical
    practice by initiating a conference series to
    provide a forum for discussion
  • Provide an open environment for discussion of
    controversial issues in clinical emergency
    medicine
  • Promote discussion of these issues among all
    physician groups, both faculty, and trainees

4
Design
  • Residents surveyed to identify the clinical
    topics
  • Series of topics chosen for discussion at monthly
    conference series (2 topics per 1 hour session)
  • Prior to conference, faculty were surveyed via
    email or survey monkey regarding their clinical
    management of a topic
  • Results of survey presented at conference
    attended by residents and faculty

5
Clinical Practice Variations Conference
6
Topics Chosen Since Initiation of Program
7
Sample Questions
  • Do you always order an ethanol level on patients
    that have been drinking alcohol?
  • If not, how do you decide which patients to order
    it on?
  • Do you order vitamins for your alcoholic patients
    that present intoxicated? If so, via which route?

8
Sample Answers
  • Only in the chronic alcoholic type patients who
    might be deficient in these vitamins, and then
    only if they can't take the folate/thiamine/MVI
    by mouth (difference is pennies vs. hundreds of
    dollars for banana bag).  I don't give to younger
    patients who were just out "partying."

9
Sample Answers
  • I dont give them IV. If the pt is an alcoholic,
    I order PO MVI, thiamine, and some food.
  • Ill administer IV vitamins if I suspect chronic
    alcoholism and nutritional issues, with delirium
    or stigmata. Otherwise oral or no therapy is
    fine.
  • If patient systemically ill, emaciated, or being
    admitted for reason other than EtOH .

10
Sample Answers
  • Not IV. No evidence for benefit.  If I am
    concerned about their vitamins I give a PO
    multivitamin, thiamine and folate when they are
    awake.
  • No, I dont order it. Its not useful as far as I
    am aware.

11
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12
Results/Discussion
  • Residents found conferences extremely helpful in
    understanding why the practice variations occur
  • Discussion allowed the residents to weigh the
    pros and cons of each style of management

13
Results/Discussion
  • Residents could decide whether the reasoning
    behind decisions was appropriate based on the
    discussion
  • Discussion helpful in allowing attendees to
    develop a plan when next presented with the
    clinical issue

14
Results/Discussion
  • Conference series initiated so much interest that
    the faculty surveyed asked for the results of the
    survey and for their own additional conference
    series which we then initiated
  • Promoted more discussion on controversial
    management topics at our program

15
Final Remarks
  • A clinical practice variation conference series
    is a unique way to address the confusion that can
    occur among residents dealing with differences in
    practice patterns at a training program
  • Developing a conference series like this requires
    little money or technology and can be highly
    productive and improve teaching and discussion at
    a training program
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