Knowledge translation is a dynamic iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of people, provide more effective health services and products and strengthen the healthcare system,1 or it is any process that contributes to the effectiveness and timely incorporation of evidence-based information into the practices of health professionals in such a way as to effect optimal healthcare outcomes and maximise the potential of the healthcare system.2

These two definitions, with only a minimal difference between them, were stated at a consensus conference in May 2007 in North America, a gathering supported by the Society for Academic Emergency Medicine there; its proceedings were published just 3 months ago.

The conference noted that knowledge translation—or “KT” as it is known to the cognoscenti—has arisen as an academic entity following the view that “there is a gap, and in some instances a chasm, between what is known from high quality clinical research and what is consistently done in clinical practice”3 and is a phenomenon that has recently been rediscovered by academic and organised medicine.4 Many clinicians from many different countries and from many different disciplines are studying this problem, and some have been studying it for many years.

Emergency physicians will probably be most aware of knowledge translation (without realising that that is what it is called) through the application of the clinical decision rules (CDRs), better known as the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule and the Canadian CT Head Rule. Many readers will recall the gradual implementation of the Rules into their own practice, and how over the years there has been a steady stream of literature confirming their validity in different settings, different countries and by different groups of practitioners. Recently a paper was even submitted to this journal on whether the Ankle Rules can be self-applied by the patient. Readers may consider that a regular feature published here—our series BestBETS—is also an example of knowledge translation.

CDRs, when well developed and validated, do help improve and standardise care, but even so it is wise to keep auditing their impact. The consensus conference reports that the CT Head Rule had no impact on CT imaging use, with rates increasing from before to after at both the control and the intervention hospitals.5

Apart from the specific introduction and application of these types of rules into practice, there is also the question of how information technology is used to support and implement them. When clinical practice guidelines are put into a computer format, it is imperative to focus on how the application will support workflow processes and the delivery of clinical care.6

Ten commandments for effective clinical decision support include such nuggets as “speed is everything”, “anticipate needs and deliver in real time”, “fit into the user’s workflow”, “recognise that physicians will strongly resist stopping” and “changing direction is easier than stopping”. There are also seven recommendations to consider when working out how informatics can best support knowledge translation in the emergency department, each accompanied by a list of priorities for future research.7

Other areas addressed by the conference include the underlying theories of knowledge translation, questions asking whether evidence-based reviews and databases are worth the effort, how all of this applies to paediatric emergency medicine, what are the cognitive and social issues relevant to our specialty, how knowledge translation can be applied to continuing medical education and professional development, the impact of healthcare policy, legal and ethical considerations and how knowledge translation can be applied both internationally and to pre-hospital care.

As Jerris Hedges states, “we should embrace knowledge translation as a tool that will help us incorporate the reasoning and experience of others into our practice. It is not a task for the faint, as it is the challenge of science itself. The formation, application and questioning of new knowledge is never ending”.4

The key to success is to ensure that in knowledge translation knowledge is not lost in translation.