Critically appraise a scientific publication for its strengths and weaknesses and its relevance to the health management research question

Evidence Informed Decision Making

Length: Max 1500 words
Weighting: 40 marks, 40%

Task Description:

Prepare a report for the CEO and Hospital Board

Scenario

You are the Chief of Operations of an acute tertiary hospital in inner Melbourne.

Your hospital’s routine practice is for all elective surgical patients to be reviewed in person by the treating surgeon or member of the surgical team, generally within the first two weeks after their surgical procedure and post-discharge from hospital.

One way the ‘quality’ of the surgery and care provided is measured is by reviewing the number of patients who present with post-surgical complications (e.g. bleeding, infection) within 30 days of discharge from hospital.

Currently, your hospital is performing very well, with the rate of post-surgical complications within 30 days of discharge consistently below the Victorian state benchmark.

Due to the impact of the COVID-19 pandemic on acute services, your hospital is required to deliver some non-urgent outpatient appointments via telehealth. You are responsible for the operations of the hospital and have been tasked with helping the surgical services transition to telehealth for non-urgent post-operative appointments.

You are aware that telehealth or ‘virtual care’ offers many benefits for the right patient population.

Regional patients who already receive telehealth services from your hospital have consistently reported high levels of satisfaction in patient experience surveys.

However, this telehealth service is not currently available for post-surgical patients at your hospital and the safety of this model of care has not previously been investigated.

At the most recent ‘Hospital Executive Huddle’, a distinguished Professor of Surgery and Head of Department expressed his reservations, commenting that there is a risk that ‘patient safety may be compromised’ and ‘potentially missing post-operative complications’ with telehealth visits.

The CEO has requested that you consider the available evidence to determine the appropriateness of telehealth services for non-urgent post-operative surgical care at your hospital. She takes you aside and stresses that “whichever way you recommend, there should be no increase in the number of post-operative surgical complications, otherwise we will never hear the end of it.”

For this assessment, assume that the only evidence that exists in the world are in the following two papers:

1. Harkey K, Kaiser N, Zhao J, Hetherington T, Gutnik B, Matthews BD, Kelz RR, Reinke CE. Post-discharge Virtual Visits for Low-risk Surgeries: A Randomized Noninferiority Clinical Trial. JAMA Surg. 2021 Mar 1;156(3):221-228. doi:10.1001/jamasurg.2020.6265. PMID: 33439221; PMCID: PMC7807392.

2. Healy P, McCrone L, Tully R, et al. Virtual outpatient clinic as an alternative to an actual clinic visit after surgical discharge: a randomised controlled trial. BMJ Quality & Safety 2019;28:24-31. https://qualitysafety.bmj.com/content/28/1/24

Prepare your response to the CEO and Hospital Board, by first critically appraising each of two papers listed above.

Using your critical appraisal skills, please write a report (max 1500 words) to the CEO and Hospital Board advising them that you support or reject the implementation of a telehealth / virtual care service for non-urgent post-surgical outpatient appointments at your hospital.

Consider the important methodological shortfalls you have identified from your critical appraisal, an understanding and analysis of the results and the significance of their findings.

Finally, you should apply the study findings that are relevant to your hospital and clinical service and where appropriate, make evidence-based recommendations.

Carefully explain your reasons, arguing for or against the intervention(s) based on the two articles above and applying the different principles of EIDM you have learned during this
course.

Learning outcomes

• Critically appraise a scientific publication for its strengths and weaknesses and its relevance to the health management research question

• Identify the possible impact of all other factors that are to be taken into consideration when seeking to implement evidence into health management practice

• Understand the meaning of knowledge and evidence and how this relates to the ‘accepted’ knowledge base and to one’s own decision making

• Identify the role of the level of evidence managers required according to the different types of decisions that managers make

• Introduce the approaches to communicating evidence-based
medicine/science with your staff and patient populations

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