Evidence-Based Decision Making & Health Technology Assessment for Critical Care, Anesthesia and Surgery (Knowledge Translation): Building a Centre of Excellence
Patient Safety and Quality of Care
Technologies and innovations for surgery, anesthesia and critical care are burgeoning, and each of them brings purported benefits. How shall we choose amongst the many ‘goods’? Our Know4Go project transformed hospital decision-making regarding which health technologies to adopt and which to forgo through an innovative approach that improved value for money while ensuring accountability to evidence, ethics, economics, and contextualized social/legal/ethical issues (ie, the ‘sleepers’). We increased effective evidence translation across a multitude of technology decisions, both locally and internationally, by ensuring end-users and decision-makers work in tandem to recognize, contextualize, and decide on the evidence. Overall, this approach superceded ‘$2-for-1’ return on investment. This approach has the potential to revolutionize decisions and value for money in healthcare if applied more broadly.
We developed and implemented Know4Go within a local hospital-based health technology assessment program (HB-HTA) to improve evidence-informed decision-making, contextualized knowledge translation, and value for money , with a particular focus on technology decisions in surgery, anesthesia, and critical care. This innovative approach brings HTA to the place where it is most relevant – to the decision-makers in the hospital who work within a specific context, under a fixed budget, and who are closest to understanding the local priorities and feeling the impact of trade-offs that will be made by taking up one decision and forgoing another. This is in contrast to usual decision-making, which is often done without involving end-users, without explicitly consulting pre-existing evidence or HTAs, and without a mechanism to bring contextualized factors to bear. The Know4Go framework moves HB-HTA a step further by making explicit whether a decision for a new technology should be a ‘go’ or a ‘no-go’, or whether more research is required. Know4Go makes tradeoffs explicit by combining contextualized clinical evidence and economic evidence together with the ‘sleeper’ factors (ie, social, legal, ethical, environmental, political, entrepreneurial/innovation, research, and stickiness factors) which often prematurely trump decisions if they are not systematically addressed. Together these concepts address constant expansionary pressures associated with health technologies –one of the largest cost drivers – at the hospital level. By applying this framework to multiple technology decisions in hospitals locally and internationally, we have achieved more than ‘$2-for-1’ return on investment at the hospital level. Hospitals and governments have requested expansion of the toolkit to apply to areas beyond surgery and critical care.