The most recent data from the Centers for Disease Control (CDC) suggest that nearly 2% of surgeries in the U.S. result in surgical site infections (SSIs) — post-surgical infections occurring in the part of the body where an operation was performed. The mortality rate for SSIs is 3%, which means that for the 14.2 million inpatient operative procedures in 2014, there were an estimated 8,000 SSI-associated deaths.
In 2017, JAMA (Journal of the American Medical Association) Surgery published the updated CDC Guideline for the Prevention of Surgical Site Infection. The piece was co-authored by Penn Biomedical nurse librarian Sherry Morgan, PhD, along with analysts from Penn’s Center for Evidence-based Practice (CEP) and a team of clinical experts. According to the article, “approximately half of SSIs are deemed preventable using evidence-based strategies.” These strategies include pre-surgical bathing, alcohol-based disinfectants in the operating room, and increased oxygen both during and post-operation.
That updated guideline earned the distinction of most-viewed JAMA article for that year.
It was established by following the same empirical procedure as a “systematic review,” a research method which requires combing the literature for all relevant topical data, evaluating it relative to pre-specified criteria, and synthesizing the resultant information into practical recommendations. Systematic reviews fall under the umbrella of what is termed “evidence-based practice” — the raison d’être of CEP.
“CEP was established in 2006 to support patient care quality, safety, and value through evidence-based practice,” explains Nikhil Mull, MD, Director of CEP. “To accomplish this mission, CEP performs rapid systematic reviews to inform institutional decision-making. CEP has had a long-standing relationship with the Penn Biomedical Library, but the two have more recently partnered to draw on the strengths of the Biomedical librarians to more efficiently answer increasingly complex clinical questions arising throughout the Penn Medicine system.”
Indeed, the two entities are now piloting a process that would expedite systematic reviews to address pressing clinical questions. Biomedical librarians manage the first steps (developing search strategies, conducting the searches, and organizing the results), while CEP analysts subsequently vet and synthesize the results. This tentative arrangement aims to reduce turnaround time between clinical request and final report. Moreover, “with this new pilot collaboration,” says Mull, “CEP staff can more effectively juggle multiple projects while providing the librarian team with practical clinical exposure for systematic reviews.”
There are a number of advantages to systematically searching and reviewing the biomedical literature versus expert clinical opinions, foremost among them being the sheer quantity of data taken into consideration. “With the rapid rate of publication in the health sciences, a lone doctor cannot possibly review and evaluate all of the available information on a given topic,” says Barbara Cavanaugh, Director of the Biomedical Library.
That’s where librarians come in. Librarian Maylene Qiu — who has a background in both pharmaceuticals and library science — coordinates the Biomedical Library’s systematic review service and represents the Library in weekly CEP meetings. “Maylene has refreshed the Library-CEP relationship in a potentially powerful way,” notes Cavanaugh.
In the past, medical professionals would rely on a combination of information recall, critical thinking, peer or mentor consultation, and individual research to make clinical decisions — an imprecise and limited process. Systematic reviews, on the other hand, determine the best evidence, enabling clinicians to combine their own clinical expertise with consideration of the patient and question at hand — and thereby realizing CEP’s mission “to support patient care quality, safety, and value.”