Friday, December 18, 2009

Peer reviewed? Not quite . . .

An email from Nebraska to our research librarians. I love this! The blog takes precedence over medical journals.

Sent: Thursday, December 17, 2009 3:33 AM
To: Research,Medical
Subject: iv blood draw study

In our E/R, we routinely draw blood for lab work off of IV starts. We do this to speed results and to spare the patient an unnecessary stick.

Our administration recently asked us to write a policy to define our procedure and best practices. In an extensive literature search, I came across a piece about this very topic in Paul Levy's "Running a Hospital" Blog. ("Fixing bad blood tests", dated 11/5/2008)

We will probably do an internal study similar to that described in the blog. Any information about the procedures or data from your study would be helpful to me. If you formulated a formal policy as a result of the study, I would very much like to get a copy.

Can you help me, or refer me to the people at your hospital who conducted the study?

Any assistance you can give me would be greatly appreciated.

[named omitted] BA RN EMT-P CEN
Emergency Department
Saint Elizabeth Regional Medical Center
Lincoln, NE


Anonymous said...

Ha! Coming from my side of the barn, this is interesting. First, someone from the ER wouldn't have much idea what journals to look in, as they would mostly be pathology journals. Second, why wouldn't he ask his lab colleagues for advice on formulating this policy?
Third, sounds like you better get all the technical details right in all your blog posts, since you're now a cited reference! (:

Last, since it's been a year since that post, a follow up report on your own ER hemolysis results would be interesting to me. It would shed some light on the sustainability of interventions, which was always a problem in my institution. (I know I'm going to make someone hate me - is it Alice? (:)


Paul Levy said...

I'll ask Alice...

Anonymous said...

The power of peer reviews on blogs...

Two days ago your CIO published on his own blog a snapshot of the AtriumHealth system. We pointed he not only showed actual patient data (room number, medical condition, physician name) but he also exposed the login url of the system (revealing many weaknesses such as no firewall, no multiple failures enforcement, etc.)
Outcome? the incriminating document was promptly sanitized on the geek blog but the reader comment was also conveniently sent to a black hole!!!
At least the blog offered a peer review opportunity :)

Alice Lee said...

Anon 246p,
Thank you for asking. Yes, the hemolysis rate continues to be low.

e-Patient Dave said...

Speaking of peer review, did anyone else notice the essay In Search of an Optimal Peer Review System in the inaugural issue of the Journal of Participatory Medicine?

"After 30 years of practicing peer review and 15 years of studying it experimentally, I’m unconvinced of its value. Its downside is much more obvious to me than its upside, and the evidence we have on peer review tends to support that jaundiced view."

And who wrote this? Why, it's Richard Smith, 25 year editor of the British Medical Journal. It's quite a thoughtful article, and it should be required reading for anyone who cavalierly insists on journal evidence.

"Sadly, in my experience, most scientific editors know little about the now large body of evidence on peer review. So paradoxically, the process at the core of science is based on faith rather than experimental evidence. ... We struggle to find convincing evidence of its benefit, but we know that it is slow, expensive, largely a lottery, poor at detecting error, ineffective at diagnosing fraud, biased, and prone to abuse."

Seriously. Go read it.

Engineer on Medicare said...

The article on peer review by Richard Smith of the British Medical Journal is very much on target in promoting openness of the publication and peer review of reports of scientific research. The material that has been revealed from the University of East Anglia on the matter of global warming illustrates why all of the data and analytical processes used to reach conclusions that will affect society must be available to anyone who wants to look at it and comment on it. It costs very little to publish and make all data available on the internet.

The best quality assurance process for any scientific publication is the knowledge of the author that the results will be subject to serious review and that if it is wrong he will be exposed and embarassed. In the worst case he may be revealed to be a fraud.

Any finding that is not supported by data and analyses that are generally available should be given no credence in the professional or regulatory community.

e-Patient Dave said...

Engineer On Medicare,

> The best quality assurance process for any scientific publication
> is the knowledge of the author that the results will be subject
> to serious review

It's equally relevant for our medical records - and the staff who reads them. Consider the horror story of Fred Holliday, reported in Washington last Monday by his widow Regina.

This is a big part of why I'm so hopeful about the Open Notes project that Paul's written about.

BIDMC's Dr. Tom Delbanco runs the project, and was one of the guests last week on a "WIHI" webcast sponsored by the Institute for Healthcare Improvement. The archive should be up soon here.