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Views And Reviews Acute Perspective

David Oliver: Fighting phantom policies in hospitals

BMJ 2019; 366 doi: (Published 07 August 2019) Cite this as: BMJ 2019;366:l4949

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Re: David Oliver: Fighting phantom policies in hospitals

I read the article 'David Oliver: Fighting phantom policies in hospitals' with great interest. I found the examples relatable to practice observed during my training. Indeed each hospital has its own variation in these 'phantom policies'.

I would suggest that this idea of doing something 'because that's the way it is done' expands beyond policies, but exists in our daily medical practice.

A notable example from the critical care population: Colloid solutions were thought to be beneficial and were often used during fluid resuscitation until the practice was examined in the 6S Trial(1) and CHEST study(2). The 6S Trial demonstrates at 90 days the use of Hydroxyethyl Starch was associated with an 8% absolute increase in mortality versus Ringer's Acetate (P=0.03) (1). CHEST found that colloid vs saline therapy was associated with a 21% increased risk of requiring renal replacement therapy (P=0.04) (2).

These trials have revolutionized the way we administer fluids. Balanced crystalloid fluids are now widely accepted as a first line in resuscitation.

I suggest that as clinicians we should examine all aspects of of practice and strive to use the latest evidence based medicine wherever possible.


1. Perner. Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis. (6S Trial). N Eng J Med 2012;367:124-134
2. Myburgh. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care (CHEST study). NEJM 2012;367:1901-1911

Competing interests: No competing interests

10 August 2019
Claire M McCaul
Anaesthetic Trainee
Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH