Dr. Charles Cowan: Finding Clinical Pathways to Standardize and Improve Quality of Care
Dr. Charles Cowan
Featured in interaction March 2007 (PDF 1.4MB)
With the creation of the Children’s Hospital strategic plan, it is clear that our quest to be the best children’s hospital continues.
One key component of Children’s Hospital strategy to become the best is to build programs that set national standards for quality of care. A way to reach this vision is through the standardization of care processes to assure best practice.
But how do we determine what is the best practice?
A standard clinical practice may not necessarily be the best because everyone is doing it. In fact, in some cases the standard practice may not be the best at all.
To determine what is the best practice and the best method of transforming theory into clinical procedure involves research — not research in the laboratory, but research in the variability in clinical treatment practice.
At Children’s Hospital, one doctor very passionate about this research is Dr. Charles Cowan.
“There are three principals to this kind of research,” Dr. Cowan explains.
“First, you need a reasonable medical evidence base that tells you the best way of doing things. Second, you determine what practitioners are actually doing in the clinic. Do they do things the same way, or a myriad of different ways? Third, you determine how to change practice to a standard that conforms to what the medical evidence actually shows.”
“What you find is that medical evidence is not always strictly being put into real clinical practice,” shares Dr. Cowan, referencing the chart on his office door. The chart is from a study he and Dr. Dimitri Christakis engaged in on the treatment of bronchiolitis, a viral lung infection.
After analyzing the treatment of thousands of patients in children’s hospitals across the country, they found that in approximately 25 percent of the cases patients were treated with parenteral antibiotics, even though it is well acknowledged that viruses cause this disorder and antibiotics do not influence the clinical course.
Their study also showed that chest X-rays were over-utilized, thus unnecessarily exposing children to radiation. This is just one example of how variability of care, both internally within a single hospital and externally among different hospitals, creates the potential for patient harm.
Standardization is a way to manage risk and improve quality by implementing procedures that put medical evidence into clinical, standardized practice.
One area close to Dr. Cowan’s heart is the standardization of the treatment of children with developmental disabilities.
Dr. Cowan is chief of the Autism Diagnostic Clinic as well as an attending physician within Children’s neurodevelopmental program. For autism, researchers are still looking for an optimal method of diagnosis, and, as a result, there are many variations in practice.
A strategy to standardize and implement newly discovered tools for diagnosis will be a necessary, but uphill battle, utilizing the three principals Dr. Cowan discusses.
There are two benefits to taking a hard look at quality improvement and standardization of practice says Dr. Cowan.
First and foremost is the decreased risk to patients, because variable practice increases errors. Furthermore, implementation in clinical settings of the most recent and valid medical evidence can improve treatment and prevent over-utilization of unnecessary procedures.
Second, there will be less waste, thus impacting cost to the hospital and the patient. So analyzing what is done and how it is done is a win-win. It reveals where improvement is necessary and establishing ways to improve and implement standard practices across the board.
Dr. Cowan’s commitment to quality improvement and the standardization of care practices is just one example of a doctor fulfilling Children’s Hospital mission and working toward its vision to become the best children’s hospital by developing the best care for our patients.