School of Medicine and Health Sciences Poster Presentations
Title: Resident Physician Response to New Research Measured by Utilization of Balanced Crystalloid vs Normal Saline
Document Type
Poster
Abstract Category
Quality Improvement
Keywords
Resident education, new research, evidence-based medicine
Publication Date
Spring 5-1-2019
Abstract
Background: Several studies published in March 2018 show that there may be a benefit to lactated ringers (LR) in terms of mortality and kidney failure for Emergency Department (ED) and Intensive Care Unit patients, however sodium chloride 0.9% (NS) is by far the most frequently used fluid in our emergency department. We seek to quantify how physicians in training change their practice based on available evidence. Methods: On August 1, 2018, our first intervention was to distribute a survey assessing general knowledge pertaining to balanced crystalloids to 40 resident physicians training in emergency medicine. Participation in the survey was voluntary and anonymous. A second intervention included a Journal Club for many of the residents which occured on September 19, 2018. After these interventions, we trended the number of LR and NS liters ordered in our emergency department starting in January 2018, before publication of the aforementioned article, and ending in November 2018. Outcomes include responses on the initial survey and change in percent of LR liters ordered in Jan 2018 compared with November 2018 using a simple t-test. Results: All residents present at morning conference were included in the study. Interestingly, only 17% of residents responded that they prefer using a resuscitation fluid other than LR. According to our data set, in July 2018, just prior to distribution of the survey, only 19% of the total fluids (LR plus NS) ordered in the ED were LR. The number of LR liters ordered in the ED increased from 1.4% of total fluid boluses ordered in January 2018 to 33.7% of the total in November 2018, a significant difference when comparing the number of liters both before and after the initial study intervention (survey) (p<0.05). Conclusion: There was a significantly higher number of LR compared with NS liters ordered after the advent of new research, survey participation, and after a journal club related to the research. This may help us understand and quantify what factors impact physician practices related to new research. Further, there appears to be a discrepancy between what residents state as their ordering preferences and the ordering practices of their emergency department.
Open Access
1
Title: Resident Physician Response to New Research Measured by Utilization of Balanced Crystalloid vs Normal Saline
Background: Several studies published in March 2018 show that there may be a benefit to lactated ringers (LR) in terms of mortality and kidney failure for Emergency Department (ED) and Intensive Care Unit patients, however sodium chloride 0.9% (NS) is by far the most frequently used fluid in our emergency department. We seek to quantify how physicians in training change their practice based on available evidence. Methods: On August 1, 2018, our first intervention was to distribute a survey assessing general knowledge pertaining to balanced crystalloids to 40 resident physicians training in emergency medicine. Participation in the survey was voluntary and anonymous. A second intervention included a Journal Club for many of the residents which occured on September 19, 2018. After these interventions, we trended the number of LR and NS liters ordered in our emergency department starting in January 2018, before publication of the aforementioned article, and ending in November 2018. Outcomes include responses on the initial survey and change in percent of LR liters ordered in Jan 2018 compared with November 2018 using a simple t-test. Results: All residents present at morning conference were included in the study. Interestingly, only 17% of residents responded that they prefer using a resuscitation fluid other than LR. According to our data set, in July 2018, just prior to distribution of the survey, only 19% of the total fluids (LR plus NS) ordered in the ED were LR. The number of LR liters ordered in the ED increased from 1.4% of total fluid boluses ordered in January 2018 to 33.7% of the total in November 2018, a significant difference when comparing the number of liters both before and after the initial study intervention (survey) (p<0.05). Conclusion: There was a significantly higher number of LR compared with NS liters ordered after the advent of new research, survey participation, and after a journal club related to the research. This may help us understand and quantify what factors impact physician practices related to new research. Further, there appears to be a discrepancy between what residents state as their ordering preferences and the ordering practices of their emergency department.
Comments
Presented at Research Days 2019.