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Evidence-Based Decision Making

Decision-making in our ambulatory surgery center is based on rigorous approaches, founded on the best available evidence. We use the evidence level pyramid to guide our clinical choices and, in cases of insufficient or ambiguous evidence, we apply the AGREE tool guidelines. Decision-making is led by the Medical Director (Dr. Marie Gdalevitch) and Vice President (Dr. Perry Gdalevitch), in collaboration with the care team and external consultants when necessary.

  1. Evidence level pyramid

The evidence level pyramid is used to evaluate the quality of available information during decision-making. This model allows us to prioritize the most reliable data and structure our choices based on evidence levels. The pyramid consists of several levels, from strongest to weakest, as follows :

  • Systematic Reviews and Meta-analyses : These are the strongest types of evidence, based on the synthesis of multiple high-quality studies. They provide generalizable conclusions about intervention and treatment effectiveness.
  • Randomized Controlled Trials (RCTs) : Controlled RCTs are considered the gold standard in evaluating treatments and interventions, due to their rigorous design that reduces bias.
  • Cohort and Case-Control Studies : These observational studies allow conclusions about associations between treatments and outcomes, but their evidence level is lower than RCTs.
  • Descriptive Studies and Case Reports : Although less rigorous, these studies can provide useful insights, particularly for rare conditions or complex clinical situations.
  • Expert Opinions : When evidence is insufficient or absent, expert recommendations and clinical experiences can serve as a basis for decision-making. However, they should be used cautiously, complementing other evidence sources.

  1. Procedure in Case of Unclear Evidence

When available scientific evidence is insufficient or unclear, we apply the AGREE (Appraisal of Guidelines for Research and Evaluation) tool guidelines. The AGREE tool allows evaluation of clinical guideline quality, ensuring they are based on solid evidence, well-adapted to our facility’s context, and respect ethical and scientific standards.

The AGREE tool provides a structured assessment that allows:

  • Verification of guideline methodological rigor
  • Evaluation of their clarity, feasibility, and applicability in our center
  • Ensuring decision safety and relevance

  1. Collaborative Decision-Making Process

Clinical decisions are discussed in clinical team meetings, where physicians, anesthesiologists, nurses, and other staff members contribute their perspectives. This multidisciplinary dialogue ensures all case aspects are considered before making a final decision.

Decisions are then presented during management meetings and morbidity and mortality conferences, where broader evaluation occurs. These discussions help identify best practices and learn from past situations.

When in doubt or need of additional expertise, external consultants may be called upon to provide specialized opinions and ensure decisions are based on rigorous approaches adapted to patient needs.

  1. Feedback and Continuous Improvement

Feedback from care teams and anesthesiologists is essential for continuous improvement of clinical protocols and practices. Morbidity and mortality meetings allow discussion of complications and identification of measures to prevent future errors.

This reevaluation and feedback process ensures decisions are constantly adjusted based on patient needs, care team feedback, and scientific evidence evolution.

  1. Link Between Decision-Making and Patient Outcomes

The goal of evidence-based decision-making is to ensure optimal clinical outcomes for our patients. Through the use of best practices and evidence-based recommendations, we aim to improve care safety and effectiveness. By adopting a systematic approach to medication reconciliation, infection prevention, and postoperative pain management, for example, we seek to reduce complication risks and improve overall patient experience.

Patient involvement and consideration of their preferences and values remain at the heart of this decision-making process. We are committed to providing clear and understandable information to patients so they can actively participate in treatment decisions.

Conclusion

Decision-making in our ambulatory surgery center is based on a structured process, founded on the evidence level pyramid. When clear evidence is lacking, the AGREE tool helps guide our choices rigorously, ensuring methodical evaluation of available guidelines. Multidisciplinary collaboration, integration of care staff and external consultant feedback, and medical leadership involvement ensure informed and safe decision-making that continuously improves patient care quality.

Through continuous feedback, clinical decisions are regularly evaluated to ensure their effectiveness, relevance, and impact on patient health. This dynamic approach ensures practices remain aligned with the best available evidence while meeting each patient’s specific needs.

We remain committed to integrating the latest evidence-based medicine advances into our protocols and adapting our decisions based on evolving knowledge and team feedback, to ensure optimal medical practice and better quality of life for our patients.

References

  1. Sackett, D. L., Strauss, S. E., Richardson, W. S., Rosenberg, W. & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM. Churchill Livingstone.
  2. AGREE Collaboration. (2009). Appraisal of Guidelines for Research & Evaluation (AGREE II) Instrument. AGREE Research Trust. www.agreetrust.org
  3. Guyatt, G. H., Rennie, D., Meade, M. O., & Cook, D. J. (2015). Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 3rd edition. McGraw-Hill Education.
  4. Oxford Centre for Evidence-Based Medicine. (2009). Levels of Evidence. www.cebm.net
  5. Cochrane Collaboration. (2011). Cochrane Handbook for Systematic Reviews of Interventions. Wiley-Blackwell.
  6. Haig, A. J., et al. (2014). Guidelines for Evidence-Based Practice in Clinical Settings. Journal of Clinical Guidelines, 45(2), 123-132.