Purpose: Clinical and administrative committees at hospitals and health systems frequently must make decisions regarding acquisition and use of new technologies, including medical devices and pharmaceuticals. It is desirable to base these decisions on clinical evidence, but often these technologies are used for multiple indications and evidence of effectiveness for one indication does not prove effectiveness for all.
Method: We present two examples of short-form evidence reports that were performed for the purposes of identifying how much published clinical evidence was available for a given technology, and the clinical contexts in which that technology was evaluated. Technologies assessed included robot-assisted surgery, a device review undertaken for the supply chain committee of our health system; and dexmedetomidine, a pharmaceutical review undertaken for a hospital formulary committee at the suggestion of the anesthesia department. Both reviews were based on systematic searches of Medline, EMBASE, the Cochrane Library, and other evidence sources.
Results were presented as tables listing the quantity and type of evidence as a function of specific clinical indications for the technology. Result: Numerous prior systematic reviews and technology assessment reports were found for surgical robots, but not for dexmedetomidine. Thus we proceeded to search for primary clinical studies on dexmedetomidine. We found over 200 relevant articles, and tabulated them by indications such as cardiovascular surgery and intubation. None of the articles pertained to the high-risk patient populations who were of particular interest to the formulary committee, but some pertained to indications of interest to the anesthesia department. For surgical robots, we summarized the findings of the existing reviews and technology assessment reports, and how many trials they found for each particular indication. The supply chain committee decided there was not sufficient evidence on the surgical robot indications about which they needed to make decisions, so they did not commission any further evidence reports. The anesthesia department commissioned follow-up reports on two dexmedetomidine indications: intubation and sedation of non-surgical patients in critical care.
Conclusion: The short-form scoping reports helped focus our center’s limited resources on literature searches and analyses with the greatest potential for affecting technology acquisition decisions and clinical practice in our health system. They also helped streamline the requesting committees' review work.
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