That last factor is a particularly important catalyst to change.
I got to thinking about evidence-based medicine upon reading news of some important research from Johns Hopkins Hospital. Reported by my colleague Cheryl Clark earlier this week, the research surrounding blood transfusions in surgery could provide an interesting test case to determine how difficult it remains to incorporate evidence-based medicine protocols and change current surgical practices.
According to the story, the evidence boils down to this:
Current research says transfusions for most surgeries should not be initiated until the patient's hemoglobin level—normally 12 to 14—has dropped to 6 or 7 grams per deciliter (g/dl). A level of 7 or 8 is considered safe. But the recommendations of three specialty societies that guide current practice leave the trigger point in question. "They say that if a patient's hemoglobin level is less than 7 g/dl, then the patient would benefit from a blood transfusion. But if it's greater than 10, they would not benefit. But they don't say what should be done if the level is between 7 and 10," Steven M. Frank, MD, leader of the study, said during an interview. Thus, many surgeons initiate transfusion when levels are at 10, while others start at 9 or 10 or 11. Additionally, surgeons vary in the target point at which they stop transfusing. Some stopping at 11 or 12, even though they could stop at 10.