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Chapter 18 - Organisms and their Environment

ISD5 Evidence-Based Dentistry.docx

Why do you do what you do?

Evidence-based dentistry informs every clinical decision that we make

1. What is quality improvement activity (QIA)?

2. What is dental research?

3. How do QIA & research inform patient care & our lifelong learning?

Who is responsible for providing evidence-based (quality, informed, ‘proven effective’) dentistry?

Everybody! Patients expect to receive good quality care & they expect you to have up-to-date skills & knowledge

GDC’s Standards for the Dental Team: sets out the standards of conduct, performance & ethics that will govern you as a dental professional

Key message: All members of the dental team are required to deliver evidence-based, quality patient care

So, how can you be sure that you are delivering evidence-based, quality dental care?

1. Maintain your skills & knowledge (CPD)

2. Quality Improvement Activity (QIA)

Clinical governance is defined as the framework through which healthcare organisations are accountable for continuously improving the quality of their services & safeguarding high-quality care.

Clinical governance encompasses quality assurance, quality improvement & risk management

E.g. quality improvement activity, clinical audit plays a key role in allowing healthcare professionals to review and evaluate the quality of their work

Clinical governance is often described as having 7 pillars- they consistently recognise the importance of clinical audit as an activity that helps to sustain and improve standards of care

A brief history of the importance of QIA

Bristol Heart Scandal

Bristol heart scandal 1995, anaesthetist, Dr Stephen Bolsin, exposed the high mortality rate for paediatric cardiac surgery at Bristol Royal Infirmary

The enquiry found that between 1986-1995 over 170 children died who would have survived in other Trusts

Francis Report

Inquiry, published in 2013 for Mid Staffordshire

Identified issues of lack of leadership, ineffective communication, poor organisation and teamwork and a lack of assessing the quality of care.

Department of Health identified that 10% of inpatients' adverse events results in harm to patients and half of these errors were preventable.

Litigation between 1998 and 1999 from adverse incidents cost the NHS £400 million

Government conclusions:

Work towards guaranteed national standard of excellence

A system of clinical governance was introduced into all NHS Trusts in order to ‘guarantee patient safety and quality care'

NHS Improvement & NHS England work together to help improve care for patients and provide leadership and support to the NHS

Support providers to give patients consistently safe, high-quality, compassionate care within local health systems that are financially sustainable

The purpose of QIA:

To allow you to review and evaluate the quality of your work

Reviewing your practice against local, regional, or national benchmarking data where this is robust, attributable, and validated.

Self-checking process (open, transparent, patient safety)

To identify what works well in your practice and where you can make changes

To reflect on whether changes you have made have improved your practice or what further action you need to take

Quality rather than quantity – but annual

CLINICAL GOVERNANCE

QIA must be robust, systematic & relevant to your practice

QIA projects are repeated to ensure standards are maintained or to check they have improved if your practice has fallen short of the gold standard

Repeat projects will identify improvements that are made to patient care if you have learned from your QIA & adjusted your practice in line with the guidance

Examples of QIA:

Case based discussions

Service evaluation (no predetermined standard)

Revising practice policies

Learning event analysis (morbidity and mortality meetings)

Clinical audit

Clinical Audit

Audit in healthcare is a process used by health professionals to assess, evaluate & improve care of patients in a systematic way

Audit reviews your practice/performance against a defined (desired) standard

An audit is an example of QIA that forms part of clinical governance, which aims to safeguard a high quality of clinical care for patients

Audit Examples:

Radiographs you have taken

Referral letters written

Waiting times for an appointment at your clinic

How successful your smoking cessation advice is

How long your restorations last

National audits

The Audit Cycle

What is the difference between QIA & Research?

• All of the dental team must be involved in QIA

• All of the dental team can be involved in research

• Clinical audit asks: Are we doing the right thing, in the right way?

• Research asks: 'What should we be doing?

In other words (Differences between QIA & Research)

• Clinical audit finds out if we are doing things according to the accepted or gold standard

• (is our practice evidence-based?)

• E.g. Are we prescribing antibiotics in accordance with guidelines?

• Research finds out brand new ways of doing things & generates knowledge that we didn’t previously have

• (develops the evidence base)

• E.g. Is this new material better than an existing one for dressing root canals?

Are there similarities between QIA & Research?

• Both involve standardised & well - defined processes

• Both require formal registration and reporting of projects

• Both inform patient care & evidence-based practice

Research develops evidence-based: tells us what to do in our daily practice, develops guidelines, tells us what to teach & learn (at UG level and throughout our career)

A vast amount of dental research is generated daily

You need to be able to filter what you need & what you can believe

Systematic Reviews and Meta-Analyses:

Research methodology that is designed to find, evaluate and summarise the findings of all studies that have been designed to answer your research question

Make the available evidence more accessible

By merging the findings of multiple studies with statistical methods they can answer whether there is a believable and true effect e.g. of a new drug or material or treatment

Randomised Control Trials:

Subjects are randomly assigned to one of two groups: one (the experimental group) receiving the intervention that is being tested, and the other (the comparison group or control) receiving an alternative (often conventional or placebo) treatment.

When well done – robust methodology and ‘believable’ results (also check the methods used are appropriate. Check the population studies represent the population you work with. Is it applicable?

Qualitative Research: Type of research that explores and provides deeper insights into real-world problems. Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research gathers participants' experiences, perceptions, and behaviour – interprets & understands. May use words & images to gather & analyse data.

It answers the hows and whys instead of how many or how much. It could be a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data.

Laboratory-Based Research: Often includes biomedical science, advanced materials and dental procedures through collaborating with scientists, engineers and industry professionals.

Development & iterative testing of clinical workflows, investigating the Cell-Material interactions for regenerative procedures, aiming to develop digital platforms that help dental clinicians and patients inform decision-making processes.

Pedagogic Research: https://www.liverpool.ac.uk/eddev/ Supporting the development of learning and teaching practice at the University - the goal of improving the quality of education locally and further afield, through dissemination of best practice.

Birth Cohort Studies: Follows a group of people that were born at a similar date or period of time – be it a day, month, year or decade. It follows these people throughout their lives and collects information from them at particular ages.

https://www.liverpool.ac.uk/children-growing-up-in-liverpool/

C-GULL study: new longitudinal birth cohort focused on improving the health & well-being of children and families in the Liverpool City Region. Aims to reduce health inequalities by collecting data from 10,000 families to provide valuable insights into how we can improve health outcomes for children

https://www.liverpool.ac.uk/dentistry/research/

How does a research idea become evidence to guide the practice of dentistry?