Speaking the Language of Medicine: The Larger Benefits of Evidence

Based PracticeJim Shea MS, CTRS

tjshea@bpthosp.orgBridgeport Hospital

Bridgeport CT

The recognition and interpretation of a stimuli that serves as the basis for understanding or for motivating a particular action or reaction

It All Begins With...

PERCEPTION

Direct input creates our perception

Each fact we receive builds the case

What you see is what you get

Bottom Up

We make inferences about what we see and try to make a best guess

Prior knowledge and past experiences are critical

We develop a PERCEPTUAL HYPOTHESIS based on this prior knowledge

Top Down

We actively construct our perception of reality

Input enters and is combined with what we already know

The First Way Errors Can Occur

When things are presented in a familiar context, we rapidly judge

When we rapidly judge, we no longer look for details that we assume to be present

The 2nd Way Errors Can Occur

Hypothesis testing occurs to make sense of the input coming in

The formation of an incorrect hypothesis will lead to errors in perception

Filtering incorrectly validates this hypothesis

The 3rd Way Errors Can Occur

Previous experience working in a nursing home◦Diversion◦Quantity = Quality

How did this error occur?(prior knowledge)

The word RECREATION Implies diversion Implies fun, non clinical……..

•Para professional provide recreation•He saw some of the similar activities being conducted that he saw being offered in the nursing home

How did this error occur?(prior knowledge)

Treatment Team Meetings ◦Too much emphasis was placed by the CTRS in discussing the details of the activity and not enough emphasis on the outcome example: baking

Some Was Our Own Doing

The patient played... The patient had fun doing… The patient enjoyed...

Words That Worked Against Us

Despite efforts to educate and highlight the therapeutic nature of what we were doing, the hypothesis was established filtering confirmed the hypothesis

“Patients have told me…”

On the one hand, we believed that we were a good department that provided high quality, effective therapy.

On the other hand, we were being told we were nothing more than a service that is providing diversional activities to keep people busy.

This Created Cognitive Dissonance For Us

Focus on more supportive beliefs that outweigh the dissonant belief or behavior (He doesn’t know what he is talking about)

Reduce the importance of the conflicting belief (What he believes is not important)

Change the conflicting belief so that it is consistent with other beliefs or behaviors

We Had Three Choices

Part of the answer was close by (music therapy)

Part was to pay attention to what was valued

What to do?

EvidenceOutcomesBest Practice

The Language of Healthcare

Mission/purpose of unitLength of stayAvailable resources (space/budget/staff)

AssessmentActivity AnalysisA belief that there was evidence

Interventions were selected using traditional considerations

To bring it in line with other disciplines

To improve patient careTo change perception

Decision was made to go through a process to validate (or invalidate) programming

Research to validate current interventions

Research (or lack of research) that does not support the use of some interventions

Research to add additional interventions

Examine the research that supports the treatment provided

Limited studies to directly link specific RT interventions with desired outcomes◦ Diagnosis◦ Interdisciplinary treatment goals◦ Setting

Some practical challenges

Studies that directly connect an intervention with the exact desired outcome for the exact population

Studies that show an intervention with similar characteristics linked to the exact desired outcome for the exact population ◦ Intervention◦ Outcome◦ Population

Look for studies that are as close as possible to the ideal

Once The Evidence Was Established, We Validated The Results Creation of an outcomes tool that consisted

of 4 questions

◦ The Therapist Was Respectful◦ Goals Of The Session Were Explained◦ The Session Kept My Interest◦ The Session Helped Me Make Progress Towards My

Treatment Goals

As Well As Patient Comments

There were 204 surveys completed in a 3 month period

A report was created that summarized the findings

The overall rating was 4.6/5

The report examined the 4 variables for each intervention (group).

Particular attention was paid to the question asking the patient to rate to what degree the session helped them achieve their overall treatment goals (4.5/5).

There were 46 patient comments made and 44 were positive comments (95.65%).

How Did Perception Change? Formal presentation of evidence to support

clinical practice to psychiatric leadership team

Outcome Measure◦ Each session for 3 months

Development of departmental treatment team report guidelines

Words Matter The patient played...

The activity

The game

The patient came to recreation

The patient engaged in…

The session

The structured task

The patient came to therapy

Invited MD’s to monitor report in treatment team (forced filtering)

Recent Vacancy

How Did Perception Change?

How Did Self Perception Change?