World Patient Safety Day

September 16, 2020
Each night we all sit transfixed on the television news, daily we listen to radio broadcasts, trawl the internet and the newspaper with hope. We wait, holding our breath and listening for the words “research breakthrough’’.  

For now, perhaps more than any other time in our lives we are aware of the vital impact of health and medical research on our lives.  

September 17 marks the World Health Organisation’s,World Patient Safety Day and we have an opportunity to acknowledge the importance of independent, robust research and its evaluation and translation into best practice care. We acknowledge ‘evaluation and translation’ is not as thrilling as the latest ‘game changer’ or as exciting as the latest million - or even billion - dollar ‘boost to research’. However, it is only the transition of research into practice that can impact real people. It is this translation of research into practice that saves, and at times takes, lives.  

More than 4000 health articles are published every day, last week alone 948 studies were published or registered in relation to the coronavirus (COVID-19) alone. More and more research is being published. Some of it is high-quality, independent, evidence-based, some of it is ‘fake news’. The big question now is how do we -the health system, government, governing bodies, clinicians- ensure patients, people, benefit and are kept safe from all this emerging evidence (with varying degrees of “truth”). Whose responsibility is it and how do we wade through all of this information to determine what is best-practice?  

Historically, it can take decades to fully translate research into practice and see improved health outcomes for patients. Today, as we tackle a pandemic and an increasing tide of broader chronic disease our patients and our clinicians don’t have that sort of time.  

Living evidence guidelines provide the key. Stroke Foundation has partnered with Cochrane Australia to develop and pilot next generation evidence translation and innovation tools to deliver the Living Guidelines for Stroke Management. A three-year pilot, funded through the Australian Government Medical Research Future Fund (MRFF), this approach has the potential to transform the translation of evidence into practice, slashing timelines from publication to implementation from years to months. Its benefit extends well beyond stroke to a range of conditions.  

Excitingly, lessons and expertise from this pilot are being utilised shape best practice guidelines to support Australian doctors and nurses in managing COVID-19 – enabling this guidance to be widely available at amazing speed. 


How does it work?  

Living Evidence uses continuous evidence surveillance and rapid response pathways to incorporate new relevant evidence into systematic reviews and clinical practice guideline recommendations as soon as it becomes available.  

Practically, this means that living systematic reviews and living guidelines:  

- Are underpinned by continual, active evidence surveillance artificial intelligence and monitoring.  

- Rapidly incorporate new important evidence that is identified.  

- Can communicate in near real-time the current status of the review or guideline, and any new evidence being incorporated in the recommendation/s.  

In addition to continuous updating, Living Evidence aims to improve the quality, use and value of evidence synthesis activities by:  

- Engaging large and diverse groups of clinicians, researchers, patients and the broader community to be actively engaged in finding and appraising evidence.  

- Broadening the range of research and health-related data that can be included, such as real-world data from clinical quality registries and individual patient-level data.  

- Publishing recommendations in multi-layered digitals formats that can be integrated at the point of care into electronic medical records and decision support tools.  

- Using structured (semantic) data to improve the discoverability and reuse of research and health-related data.  

In short, living evidence takes information and uses artificial intelligence and citizen science to support traditional peer review to evaluate health and medical research. It then translates this into up to date guidelines online with an expert reality check, to be accessible to anyone at anytime, anywhere.  

More is being invested in research today than ever before, even before COVID-19, the Federal Government had announced billions were to be invested through the establishment of the MRFF. We must translate research investment into routine clinical practice to see its benefits realised.  

The value of a living evidence approach is well recognised in Australia and internationally. Ten of Australia’s peak not-for-profit, Australian-based organisations have come together with Cochrane Australia to form the Australian Living Evidence Consortium championing this approach. Much of the hard work in developing technology, systems and robust processes has been started. Australia is leading the way globally and we have an opportunity to build on this strong foundation. To continue and expand on it benefiting patients and delivering health dividends now and into the future.  

The result is a better and safer health system, delivering best-practice treatment to all that is more sustainable. A research breakthrough that will save lives – the news we are all waiting for.