Friday, 14 January 2011


Secondary Prevention After Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation Into Practice -- Williams et al., 10.1161/CIRCULATIONAHA.110.981068 -- Circulation
Until relatively recently, reporting of outcomes (especially in cardiac surgery) was perceived as being the key towards quality improvement. The past 6 to 12 months has seen a shift towards ensuring that the
right practice is adopted. I suppose the notion that if the practice is right, good outcomes will follow must be correct. As is usual in healthcare, new terms have appeared - so we've had bundles of care and we've had checklists. Measuring practice instead of outcomes is not new. It used to be called clinical audit! The weak link in audit has always been the final step ie how do you get people to change behavior and practice. The threat of being named and shamed in a re-audit may have influenced a few people. I suppose Quality improvement initiatives like the one described in this paper, that aim to change clinicians' behaviour are good examples of Nudge - the new philosophy of libertarian paternalism so beloved of our current political leaders - and I thought that paternalism in medicine was frowned upon. More in that on another day!
PS for those not familiar with Monty Python the photo is a still of Eric Idle and Terry Jones from the (in)famous Nudge Nudge Wink Wink sketch
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