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ItemClinical application of evidence-based surgery: the role of audits in surgical practiceChiang, David Ting-Wei ( 2008)Evidence-Based Medicine (EBM) is the integration of clinical practice with research evidence. The development aims to respond to the limitations of traditional expert recommendations as a guide to clinical practice. It has become a paradigm shift in the way clinicians learn and practice medicine [1-3]. Audit has been recognized as a form of EBM. Although the basic form has been practiced by some great surgeons since last century, often surgical practice has been based on ‘the tradition‘. The universal acceptance and practice of audits in surgery is only recent [4-6]. The aim of the project was to conduct audits for current surgical practice, and observe whether the evidence influence its practice. To achieve the aim, the thesis consisted of six studies, which were designed to investigate three aspects of surgical practice, including quality care assurance, cost-effectiveness of healthcare resources in surgical practice, and validation of a new surgical technique.
ItemThe role of a Medical Emergency Team in a teaching hospitalJONES, DARYL ( 2009)Modern hospitals treat patients with increasing co-morbidity and complexity. Multiple studies have shown that up to 17% of patient admissions are complicated by a serious adverse event. Such events are often not related to the patients underlying medical condition and may result in morbidity, permanent disability, and in up to 10% of cases, death. Serious adverse events are often foretold by the development of new complaints that manifest in derangements of commonly measured vital signs. The Medical Emergency Team is a team of intensive care doctors and nurses with skills in reviewing and treating patients who have become acutely unwell on the hospital wards. The team is summoned when a patient fulfil one ore more predefined criteria for activation. The chapters in this thesis present original research related to the role of the Medical Emergency Team in identifying, reviewing and treating acutely unwell ward patients, primarily at the Austin Hospital in Melbourne, Australia. The literature relating to the incidence and antecedents to serious adverse events is reviewed. The rationale behind the Medical Emergency Team and the history of its evolution in Australia and The Austin Hospital is then discussed. In the subsequent chapters, the effect of introduction of the Medical Emergency Team on the outcome of a number of patient cohorts is review including 1). the long term mortality following major surgery; 2) the incidence of cardiac arrests in patients admitted for more than 24 hours; and 3) the inhospital mortality of medical and surgical patients admitted for more than 24 hours. In addition, a survey of nurse’s attitudes to the Medical Emergency Team and potential barriers to its activation is presented. The change in Medical Emergency Team utilization with time at the Austin and Alfred Hospitals is described. Finally, the causes for Medical Emergency Team activation are examined, as is the role of the team in end of life care planning.