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INTRODUCTION

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  • Evidence, information and knowledge are components of professional activity that contribute to safe surgery if identified and applied from a system improvement perspective

  • A structured team approach is needed to improve effective use of evidence in surgical care

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SURGEONS: SEEKERS AND USERS OF EVIDENCE, INFORMATION, AND KNOWLEDGE

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It has been said that “The great questions in medicine never change; the answers do with regularity1. To address this complexity, surgeons uniquely interface with evidence, information, and knowledge (EIK). Unlike internists, who diagnose and treat through thoughtful analysis, surgeons frequently diagnose (exploratory laparotomy) and treat (colectomy) through action. Their work is as much physical and technical as it is cerebral. As tactical, tactile experts, surgeons respond to data (ie, the patient’s condition) and information (ie, diagnosis applied by an internist or other generalist after a complete analysis of those data), to draw from knowledge (ie, their training, application of evidence, and experience) to address the problem in real time. Like pilots, surgeons respond to what is in front of them to address a need. Evidence may not be as immediate a resource for these practitioners—given the performance and sometimes unpredictable nature of their roles. Surgeons routinely use published evidence prior to incision to formulate a plan of action, select tools and equipment. However, given the variations of human anatomy and physiology, they are frequently met with situations where the best plans are not adequate, and they must draw from the tacit realm of their complex knowledge base to consider what could go wrong.2 In addition, surgeons may not have the luxury of deliberation—patients don’t always appear with as complete a diagnosis as surgeons might prefer, due to the timing and urgency of the action required. In this space, the use of EIK needs to be explored as an asset that can both detract and enhance safety as it is employed with an eye toward the complexity that duality presents.

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EIK DEFINITIONS AND WHY THEY ARE IMPORTANT

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Both patient safety and EIK definitions remain underdeveloped and are therefore messy.3 Establishing shared mental models around definitions will streamline work and ensure progress. A cocreated set of definitions will explore the value of theory as an element of EIK initiatives. This philosophical work can help deter the misuse or lack of application of foundational constructs in the development of larger improvement projects, which can derail program effectiveness and sustainability.4 The goal of this chapter, however, is not to debate definitions. Therefore, the following definitions are suggested to anchor the conversation:

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  • Evidence: The scientifically sound, fully researched and validated information and collected data that have been analyzed to gain understanding and validation of a hypothesis. Evidence here is treated as an explicit resource—either hard copy or electronic—published and packaged for use by others.

  • Information: Data that are processed and repurposed and printed for distinct ...

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