Acquisition and application of new medical knowledge by anesthesiologists: Three recent examples

Abstract

Studies of dissemination of innovations in medical practice can help us understand the communication of new medical findings and improve the quality and cost-effectiveness of medical care. This study describes and analyzes dissemination of three medical findings and associated changes in clinical practice among 354 anesthesiologists in Massachusetts. The three findings dealt with potential hazards of subanesthetic concentrations of anesthetic gases (Item 1), problems caused by diffusion of nitrous oxide into body cavities (Item 2), and increased blood loss during therapeutic abortion with halothane anesthesia (Item 3). Nearly all anesthesiologists who responded to the survey were aware of these findings, but patterns of dissemination were quite different. For Item 1, but not for Items 2 or 3, there was marked acceleration in spread of awareness following initial publication of the findings. By 1976, 17 of every 20 anesthesiologists for whom the findings were relevant had changed practice because of Items 1 and 3, but only 13 of 20 had changed in response to Item 2. The average delay between awareness and change in practice was much greater for Item 1 than for Items 2 and 3. Journal articles were a dominant source of information only for Item 1. For all items, continuing education courses were a source of information significantly less often than were colleagues or published papers. Anesthesiologists were equally likely to change practice in response to a new finding whether they learned the information from published papers, colleagues or continuing education courses. Board-certified anesthesiologists tended more than others to rely on papers, and younger anesthesiologists tended more than the older to be influenced by information from colleagues.