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A vision

17 Sep. 2011 - 3.20 am, ward C1, Southend General Hospital. Night shift nurse Cathy pages the surgeon on call, Dr. Mike Jenkins.

"Please, Mike, Mrs. Chang is crying out of pain since she is back from the operating theatre. You must do something for her."
"O.K. - but this is a difficult case. She has renal insufficiency, and she's an old lady - I'm not sure how she will react to our standard analgesics. And with the new pain killers, we don't have much experience."
"Look, Mike, we got this new information system for postoperative pain - what was the name again - PAIN OUT!"
"Oh - I have heard about it - but I can't even handle my cell phone. I hate all this computer rubbish."
"Come on - even Prof. Miller uses it, and he is chair of the surgery department. So you will manage it, too. Shall I explain?"

3 minutes later, Cathy consoles the patient:
"Mrs. Chang, we will help you immediately. We will just figure out what will help you best."
Cathy turns to the flat screen on the wall and explains to Mike:
"Here, we put in Mrs. Chang's data - age, sex, type of surgery, comorbidity. Just a few seconds later, PAIN OUT shows you what has worked best in similar cases. Look, there are already data about the new pain drug - looks not bad."
Mike is not convinced. "What about side effects?"
"Look here: the adverse events section shows some cases of fatigue - but less than with our routine drugs."
"But were does all these data come from?"
"PAIN OUT runs all over Europe. They have collected some ten thousands of data sets and analyse them continuously. They call it Clinical Decision Support. It mirrors clinical reality, no more, no less."
"I only trust in findings from Randomized Control Trials. Forget your PAIN OUT."
Cathy smiles: "Let's go to the Electronic Knowledge Library. Look: Using the same parameters, PAIN OUT searches all evidence-based guidelines and meta-analyses worldwide. Oh - the Australians are the only ones who have addressed this clinical situation so far. They say there is insufficient evidence to recommend the new drugs for this situation."
"Cathy, I'm impressed. I never managed to read 300 pages of guidelines. Who has taught you?"
"It's so easy. I learned it when we use PAIN OUT for benchmarking once a week."
Dr. Jenkins is surprised: "What on earth is PAIN OUT benchmarking?"
"The benchmark module compares pain treatment outcome of our ward with those of others in Europe, based on patients' statements. We identify where we have to improve, and where we perform well. If we are below average, we go into the "Best Practice" section. Here, Europe's best departments present their concepts. If we score in the upper third, the administration delivers coffee and sweets."
Suddenly Mrs. Chang whispers: "Oh, my pain is much better. But sweets would be a good idea".