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Evidence-based Information

Bandolier tries to bring new sources of evidence-based information to its readers. We are delighted that Iain Chalmers has drawn our attention to a new quarterly Canadian publication which is of considerable interest.

Called "informed" (ISSN 1201-2475), it is published by the Institute of Clinical Evaluative Sciences in Ontario. About the length of Bandolier , it has the same theme of helping to make evidence-based clinical decisions.

Ankle rules, OK!

Issue 1 in November 1994 contains a classic report on the Multicentre Ankle Rules Study. This tested a decision aid algorithm in eight hospitals in Ontario; 200 physicians learned the rules and applied them to over 5,000 adult patients with ankle injuries. The results were impressive: a 26% reduction in the number of ankle X-rays and an 11% reduction in the number of foot X-rays, with no increase in the number of fractures missed.

Dr No and Dr Go

Another fascinating item is 'stories from the front lines'. In the first issue there is a simple description of a problem facing a small community hospital with an imminent fiscal crisis which could only be met by closing operating rooms and inpatient beds. The solution to this familiar problem was interesting.

From 65 practising clinicians, 10 "wise persons" were chosen to serve as Dr No; any clinician wishing to admit on an emergency basis to a vacant bed would have first to discuss the admission with Dr No, examining the proposed plan of management and any alternatives.

Other clinicians had to become Dr Go. Two such clinicians toured the wards to discuss with doctors and nurses which patients could be discharged today, tomorrow, and so on.

In the five weeks this scheme operated during the crisis no elective surgery was cancelled for lack of a bed, nobody slept overnight in the emergency department and nobody was transferred to another hospital for lack of a bed. The bed management policy (the "tiny perfect hospital") was continued: 110 adult beds have been reduced to 45 with still no bed problems.

Bandolier wishes that it could reprint the diagrams and rules from the ankle study - they are simple and easy to put into practice. The study is as yet unpublished, so those wanting to know more should make sure they obtain this most useful publication, which is backed up by background information available by fax or mail. It can be obtained from:-

G-106, 2075 Bayview Avenue
Toronto, ON M4N 3M5
Tel: (416) 480-6747

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