Better decisions

BMJ Best Practice and the Comorbidities Manager

BMJ Group produces the only point of care tool to support the management of single conditions and patients with more complex comorbidities.

Helping to drive quality and reduce costs

Quality improvement, patient safety, and cost efficiency are important considerations for healthcare organisations in the UK and beyond. Various interventions can address these issues, including improving staffing levels, applying clinical improvement programmes, and seeking consultancy services to manage costs.21

While these approaches can be beneficial, they often require financial investment. Another alternative is to explore existing resources that may not be fully utilised within local contexts. Decision support tools can be particularly helpful in improving patient safety and lowering litigation costs. BMJ Best Practice is one such tool, which is freely available to healthcare professionals in NHS England, Scotland, and Wales due to subscriptions provided by these nations.

Patient lawsuits stemming from misdiagnosis or delayed diagnosis carry substantial financial implications. NHS Resolution22 reveals that noteworthy diagnostic delays, such as those involving cauda equina syndrome, can lead to costs exceeding £2 million. BMJ Best Practice encompasses cauda equina syndrome and critical conditions like meningitis, aiding precise and timely diagnosis. This can directly contribute to enhanced quality of care and cost reduction.

We are very grateful to BMJ Best Practice Podcast for helping to promote the importance of best practice care and reduce the variations in standards of practice that can exist. Through promotion of these messages, which the BMJ Best Practice Podcast has helped to facilitate, we aim to support improvements in patient safety, a reduction in avoidable harm and of course linked to that a reduction in clinical negligence claims.

Nicole Mottolini
Clinical Fellow – Diabetes and Lower Limb, NHS Resolution

Bringing the evidence to the bedside with electronic health record integration

The pace of knowledge growth surpasses healthcare professionals’ capacity to effectively absorb and apply it.23 That’s why updating BMJ Best Practice topics with new and practice-changing evidence remains a priority for us.

Evidence shows that integrating BMJ Best Practice into Electronic Health Records (EHR) systems is a highly effective way of improving patient care, with a recent study highlighting the enhanced diagnostic accuracy of clinicians when utilising clinical decision support systems integrated with BMJ Best Practice.24

Meeting the changing and complex needs of patients

Staying abreast with the latest research alone is not enough. Health professionals must consistently improve their knowledge and skills. Equally, students need to prepare for practice.

BMJ Best Practice provides students with the information and tools they need to meet the changing and complex needs of patients. It also supports educators in preparing students for the next stage of their careers.

One in three adults suffer from multiple chronic conditions and most patients in the acute setting have more than one medical condition.26 This is a significant and costly global problem. Managing patients with comorbidities is hard – clinical guidelines only focus on single conditions – but failure to manage comorbidities leads to worse clinical outcomes and longer lengths of stay. In response to these challenges, we integrated the Comorbidities Manager into BMJ Best Practice.

BMJ Best Practice – Comorbidities Manager is the only point of care tool that supports the management of the whole patient by including guidance on the treatment of a patient’s acute condition, alongside their pre-existing comorbidities.

In 2023, NHS Wales and England extended their national access to BMJ Best Practice to include the Comorbidities Manager for all NHS Wales and England health and care professionals.27

The BMJ Comorbidities Manager makes it easy to add comorbidities and see their effect on any treatment plan. It also provides clear guidance of additional considerations in one singular view for the clinician.

Geraint Walker
Clinical Informaticist Critical Care, Digital Health and Care Wales

Demonstrating the impact of guidance in effectively managing patients with comorbidities

An article published in Future Healthcare Journal28 outlines the importance of taking into account comorbidities when managing patients, and how BMJ Best Practice Comorbidities Manager can support healthcare professionals with this.

The paper demonstrates the impact guidance can have by outlining how the healthcare system needs to change so that it can provide a better service for patients. The lead author and his colleagues, of whom all are clinical specialists, discuss how common comorbidities can interact with other conditions, and the risks associated with these interactions:

For people with diabetes presenting with sepsis, [BMJ Best Practice] advises a foot examination to be undertaken on admission, as foot infection and/or osteomyelitis may be the original source of infection. It is not uncommon to encounter patients with systemic infection in whom bandages have not been removed for several days. Delay in its detection may result in worsening foot sepsis and tissue necrosis.”

Gerry Rayman
Diabetes and Endocrinology Lead, Ipswich Hospital, and specialist medical adviser to Diabetes UK

Enhancing medical education and training in Canada

Ani Orchanian-Cheff helps residents in family medicine develop the skill of accessing information at the point of care by incorporating BMJ Best Practice’s treatment algorithms into her teaching sessions.

During the morning ward rounds, she introduces the evidence-based healthcare (EBHC) pyramid 5.0, a model that guides clinicians to start with synthesised summaries for clinical reference, where BMJ Best Practice plays a crucial role.

The information specialist finds that clinicians, nurses, and practitioners of family or general internal medicine, who are the primary recipients of her teachings, favour BMJ Best Practice due to its ability to offer fast and dependable answers.

Some of the things I look for in a tool are whether it’s peer-reviewed and what the reviewers’ disclosures are. I also look to see when it was last reviewed or updated, who put the tool together, and their disclosures. All of that is included in BMJ Best Practice.”

Ani Orchanian-Cheff
Information Specialist, University Health Network (UHN), Toronto, Canada