Evidence Synthesis Unit
HI-PIE’s Evidence Synthesis Unit is a collaboration of CLHSS and the Minnesota Evidence-Based Practice Center. It was created to address the need for rapid, high-quality evidence to inform clinical practice and guidelines.
We evaluate topic areas where evidence is emerging or where evidence gaps exist to inform and adapt clinical practice. Our skills and services include a range of reviews, such as systematic and scoping reviews and meta-analyses. Under appropriate circumstances, we perform rapid reviews that answer questions using a critical and rigorous but time-limited approach.
The Evidence Synthesis Unit is led by Mary Butler, PhD, MBA and Josh Rhein, MD. Bronwyn Southwell, MD is the Integration Lead and Maya Peters, MPH is the project manager.
Work With Us
The process for requesting an Evidence Synthesis review begins with filling out the CLHSS Services Request Form. In this form, we ask questions about the problem or decisional dilemma you are facing, how you will use the information, and when you need it. We review each submission to determine its suitability for an evidence review.
If your request is suitable for a review, we then schedule a Problem Framing meeting to further clarify and define your research questions.
After the Problem Framing meeting, your request is once more evaluated to determine if the scope of work fits within our Unit’s purview. If yes, a Scope of Work agreement is created, which defines the scope of work that the Evidence Synthesis Unit will undertake to fulfill your needs.
Once the Scope of Work agreement has been approved, the work of synthesizing the evidence begins. Depending on the scope and complexity, project timelines will vary from weeks to months.
After the evidence review has been completed, we will schedule a meeting to present our findings. You will be provided with final, archivable documents for your use.
Recent Evidence Synthesis Projects
Rapid Review on the Impact of the SEP-1 Bundle on Patient Outcomes
The Evidence Synthesis unit conducted this rapid review in response to a request from a clinical working group interested in understanding which aspects of the Severe Sepsis and Septic Shock Management Bundle (SEP-1) were most important for patient outcomes.
SEP-1 mandates the administration of a bundle that carefully prescribes how patients with severe sepsis and septic shock must be treated in the early phases of care. The 1-hour bundle is composed of the following five elements: measuring the lactate level, obtaining blood culture prior to administration of antibiotics, administering broad-spectrum antibiotics, beginning rapid administration of 30 mL/kg crystalloid fluid for hypotension or lactate ≥4 mmol/L, and administering vasopressors if the patient is hypotensive during or after fluid resuscitation.
For this project, we developed a broad synopsis of the available literature through an evidence map on SEP-1 compliance, fluid resuscitation, and antibiotic administration in sepsis management. We then conducted a rapid review of the literature published over the last five years.
Our review produced several key points:
- Recent evidence on sepsis patient management is limited, largely observational (non-randomized), and generally low quality.
- The field needs high-quality RCT evidence to better inform patient care.
- The evidence base for fluid resuscitation (volume) appears wide and includes several systematic reviews.
- No recent systematic reviews address the question of initial timing of fluid resuscitation, representing a research gap in this area.
- An updated review on antibiotics de-escalation is needed, as the most recent one is more than five years old.
- Little to no research has directly addressed harms of antibiotic administration for patients at low risk of infection or suspected sepsis, representing another research gap in this area.
- Key points: care bundles such as SEP-1 may improve survival; effects of fluid volume comparisons are mixed; early antibiotic administration (within 1 hour) showed no or equivocal benefit compared to later antibiotic initiation; antibiotic de-escalation showed no detrimental effect for mortality.
Please contact Toyin Lamina, PhD, MPH: email@example.com