Improving healthcare quality, patient outcomes, and costs with evidence-based practice (2023)


This chapter from Implementing the Evidence-Based Practice (EBP) Competencies in Healthcareexplains how evidence-based practice improves healthcare quality and patient outcomes while reducing costs and discusses multiple barriers to EBP that persist in healthcare settings.

"To know and not to do is really not to know."
–Stephen R. Covey

Setting the stage

Improving healthcare quality, patient outcomes, and costs with evidence-based practice (1)Have you ever wondered why the United States spends more money on healthcare than any western country, yet it ranks 37th in world health outcomes? Have you ever questioned why patients are awakened every 2 to 4 hours for vital signs in the hospital when they are stable and in desperate need of sleep? Or wondered why nurses work 12-hour shifts when research shows the multiple adverse outcomes of working lengthy hours for both clinicians and patients? Have you ever thought about the millions of healthcare dollars that could be saved if all primary care providers would follow the evidence-based recommendations of the U.S. Preventive Services Task Force? Have you ever questioned why it often takes decades for the evidence that is generated from research to be translated into the real world to improve healthcare quality and patient outcomes?

Tina Magers (nursing professional development and research coordinator at Mississippi Baptist Health Systems) and her team wondered why catheter-associatedurinary tract infections (CAUTIs) affect as many as 25% of all hospitalized patients and questioned what evidence exists that could inform a practicechange to reduce these infections in their hospital. (This is Step #0 in the seven-step evidence-based practice [EBP] process, which we describe in detaillater in this chapter.) As a result, the team formed the following question in a format called PICOT (Patient population, Intervention or Interest area,Comparison intervention or group, Outcome, and Time; Step #1 in EBP) that facilitated them to conduct an expedited effective search for the best evidence(Magers, 2015):

In adult patients hospitalized in a long-term acute care hospital (P), how does the use of a nurse-driven protocol for evaluating the appropriatenessof short-term urinary catheter continuation or removal (I) compared to no protocol (C) affect the number of catheter days and CAUTI rates (O) over asix-month post-intervention period (T)?

The team conducted an evidence search to answer this clinical question using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), theCochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE), OvidClinical Queries, and PubMed (Step #2 in EBP), followed by rapid critical appraisal of 15 studies found in the search (Step #3 in EBP). A synthesis of the15 studies led the team to conclude that early removal of urinary catheters would likely reduce catheter days and CAUTIs (the identified outcomes).Therefore, the team wrote a protocol based on the evidence, listing eight criteria for the continuation of a short-term urinary catheter (Step #4 in EBP).

After the protocol was presented to the medical executive committee at their hospital for approval, a process for the change was put into practice,including an education plan with an algorithm that was implemented in small group inservices for the nurses, posters, and written handouts for physicians.An outcomes evaluation (Step #5 in the EBP process) revealed a significant reduction in catheter days and a clinically significant reduction of 33% inCAUTIs. The team disseminated the outcomes of the project to internal audiences (e.g., their Nursing Quality Council, the EBP and Research Council, NursingLeadership Council, Organization Infection Control Committee) and external venues (presentations at regional conferences and a publication in the American Journal of Nursing) (Magers, 2013). (Step #6 in the EBP process.)

This is a stellar exemplar of how a team with a spirit of inquiry and a commitment to improving healthcare quality can use the seven-step EBP processdiscussed in this chapter to improve patient outcomes and reduce hospital costs.

Evidence-based practice and the quadruple aim in healthcare

Findings from an extensive body of research support that EBP improves the quality and safety of healthcare, enhances health outcomes, decreases geographicvariation in care, and reduces costs (McGinty & Anderson, 2008; Melnyk & Fineout-Overholt, 2015; Melnyk, Fineout-Overholt, Gallagher-Ford, &Kaplan, 2012a). In the United States, EBP has been recognized as a key factor in meeting the Triple Aim in healthcare, defined as (Berwick, Nolan, &Whittington, 2008):

  • Improving the patient experience of care (including quality and satisfaction)
  • Improving the health of populations
  • Reducing the per capita cost of healthcare

The Triple Aim has now been expanded to the Quadruple Aim: the fourth goal being to improve work life and decrease burnout in clinicians (Bodenheimer &Sinsky, 2014).

Because EBP has been found to empower clinicians and result in higher levels of job satisfaction (Strout, 2005), it also can assist healthcare systems inachieving the Quadruple Aim. However, regardless of its tremendous positive outcomes, EBP is not standard of care in healthcare systems throughout theUnited States or the rest of the world due to multiple barriers that have continued to persist over the past decades. Some of these barriers include(Melnyk & Fineout-Overholt, 2015; Melnyk et al., 2012a; Melnyk et al., 2012b; Melnyk et al., 2016; Pravikoff, Pierce, & Tanner, 2005; Titler,2009):

  • Inadequate knowledge and skills in EBP by nurses and other healthcare professionals
  • Lack of cultures and environments that support EBP
  • Misperceptions that EBP takes too much time
  • Outdated organizational politics and policies
  • Limited resources and tools available for point-of-care providers, including budgetary investment in EBP by chief nurse executives
  • Resistance from colleagues, nurse managers, and leaders
  • Inadequate numbers of EBP mentors in healthcare systems
  • Academic programs that continue to teach baccalaureat, master’s, and doctor of nursing practice students the rigorous process of how to conduct research instead of taking an evidence-based approach to care

Urgent action is needed to rapidly accelerate EBP in order to reduce the tremendously long lag between the generation of research findings and theirimplementation in clinical settings. Many interventions or treatments that have been found to improve outcomes through research are not standard of carethroughout healthcare systems or have never been used in clinical settings. It took more than 20 years for neonatal and pediatric intensive care units toadopt the Creating Opportunities for Parent Empowerment (COPE) Program for parents of preterm infants and critically ill children even though multipleintervention studies supported that COPE reduced parent depression and anxiety, enhanced parental-infant interaction, and improved child outcomes (Melnyk& Fineout-Overholt, 2015). It was not until findings from a National Institute of Nursing Research funded randomized controlled trial supported thatCOPE reduced neonatal intensive care unit (NICU) length of stay in premature infants by 4 days (8 days in preterms less than 32 weeks) and its associatedsubstantial decreased costs that NICUs across the country began to implement the intervention as standard of care (Melnyk & Feinstein, 2009; Melnyk etal., 2006).

If not for an improvement in “so-what” outcomes (outcomes of importance to the healthcare system, such as decreased length of stay and costs), COPE wouldnot have been translated into NICU settings to improve outcomes in vulnerable children and their families. On the other hand, many interventions orpractices that do not have a solid body of evidence to support them continue to be implemented in healthcare, including double-checking pediatricmedications, assessing nasogastric tube placement with air, and taking vital signs every 2 or 4 hours for hospitalized patients. These practices that aresteeped in tradition instead of based upon the best evidence result in less than optimum care, poor outcomes, and wasteful healthcare spending.

(Video) Evidence-Based Practice: Improving Practice, Improving Outcomes (Part One)

Definition of evidence-based practice

As EBP evolved, it was defined as the conscientious use of current best evidence to make decisions about patient care (Sackett, Straus, Richardson,Rosenberg, & Haynes, 2000). Since this earlier definition, EBP has been broadened to include a lifelong problem-solving approach to how healthcare isdelivered that integrates the best evidence from high-quality studies with a clinician’s expertise and also a patient’s preferences and values (Melnyk& Fineout-Overholt, 2015; see Figure 1.1).

Incorporated within a clinician’s expertise are:

  • Clinical judgment
  • Internal evidence from the patient’s history and physical exam, as well as data gathered from EBP, quality improvement, or outcomes management projects
  • An evaluation of available resources required to deliver the best practices

Some barriers inhibit the uptake of EBP across all venues and disciplines within healthcare. Although the strongest level of evidence that guides clinicalpractice interventions (i.e., Level I evidence) are systematic reviews of randomized controlled trials followed by well-designed randomized controlledtrials (i.e., Level II evidence), there is a limited number of systematic reviews and intervention studies in the nursing profession. Single descriptivequantitative and qualitative studies, which are considered lower-level evidence, continue to dominate the field; see Table 1.1 for levels of evidence thatare used to guide clinical interventions.

However, all studies that are relevant to the clinical question should be included in the body of evidence that guides clinical practice. In addition,clinicians often lack critical appraisal skills needed to determine the quality of evidence that is produced by research. Critical appraisal of evidence isan essential step in EBP given that strength or level of evidence plus quality of that evidence gives clinicians the confidence to act and change practice.If Level I evidence is published but is found to lack rigor and be of poor quality through critical appraisal, a clinician would not want to make apractice change based on that evidence.

(Click image to enlarge)

TABLE 1.1 RATING SYSTEM FOR THE HIERARCHY OF EVIDENCE TO GUIDE CLINICAL INTERVENTIONS

Level

Explanation

I

Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs)

II

Evidence obtained from well-designed RCTs

III

Evidence obtained from well-designed controlled trials without randomization

IV

Evidence from well-designed case-control and cohort studies

V

Evidence from systematic reviews of descriptive and qualitative studies

VI

Evidence from single descriptive or qualitative studies

VII

Evidence from the opinion of authorities and/or reports of expert committees

Source: Modified from Elwyn et al. (2015) and Harris et al. (2001).

The seven steps of evidence-based practice

Evidence-based practice was originally described as a five-step process including (Sackett et al., 2000):

  1. Ask the clinical question in PICOT format.
  2. Search for the best evidence.
  3. Critically appraise the evidence.
  4. Integrate the evidence with a clinician’s expertise and a patient’s preferences and values.
  5. Evaluate the outcome of the practice change.

In 2011, Melnyk and Fineout-Overholt added two additional steps to the process, resulting in the following seven-step EBP process (see Table 1.2).

TABLE 1.2THE SEVEN STEPS OF EVIDENCE-BASED PRACTICE

Step

Explanation

Cultivate a spirit of inquiry within an EBP culture and environment.

1

Ask the burning clinical question in PICOT format.

2

Search for and collect the most relevant best evidence.

3

Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, synthesis, and recommendations).

4

Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change.

5

Evaluate outcomes of the practice decision or change based on evidence.

6

Disseminate the outcomes of the EBP decision or change.


Step #0: Cultivate a spirit of inquiry within an EBP culture and environment
The first step in EBP is to cultivate a spirit of inquiry, which is a continual questioning of clinical practices. When delivering care to patients, it isimportant to consistently question current practices: For example, is Prozac or Zoloft more effective in treating adolescents with depression? Does use ofbronchodilators with metered dose inhalers (MDIs) and spacers versus nebulizers in the emergency department (ED) with asthmatic children lead to betteroxygenation levels? Does double-checking pediatric medications lead to fewer medication errors?

Cultures and environments that support a spirit of inquiry are more likely to facilitate and sustain a questioning spirit in clinicians. Some keycomponents of an EBP culture and environment include (Melnyk, 2014; Melnyk & Fineout-Overholt, 2015; Melnyk et al., 2012a, 2016):

(Video) What is Evidence-Based Practice?

  • An organizational vision, mission, and goals that include EBP
  • An infrastructure with EBP tools and resources
  • Orientation sessions for new clinicians that communicate an expectation of delivering evidence-based care and meeting the EBP competencies for practicing registered nurses (RNs) and advanced practice nurses (APNs)
  • Leaders and managers who “walk the talk” and support their clinicians to deliver evidence-based care
  • A critical mass of EBP mentors to work with point-of-care clinicians in facilitating evidence-based care
  • Evidence-based policies and procedures
  • Orientations and ongoing professional development seminars that provide EBP knowledge and skills-building along with an expectation for EBP
  • Integration of the EBP competencies in performance evaluations and clinical ladders
  • Recognition programs that reward evidence-based care

Step #1: Ask the burning clinical question in PICOT format
After a clinician asks a clinical question, it is important to place that question in PICOT format to facilitate an evidence search that is effective ingetting to the best evidence in an efficient manner. PICOT represents:

  • Sometimes, there is not a time element; therefore you see PICO rather than PICOT. P: Patient population
  • I: Intervention or Interest area
  • C: Comparison intervention or group
  • O: Outcome
  • T: Time (if relevant)

For example, the clinical questions asked in Step #0 that all involve interventions or treatments should be rephrased in the following PICOT format toresult in the most efficient and effective database searches:

  • In depressed adolescents (P), how does Prozac (I) compared to Zoloft (C) affect depressive symptoms (O) 3 months after starting treatment (T)?
  • In asthmatic children seen in the ED (P), how do bronchodilators delivered with MDIs with spacers (I) compared to nebulizers (C) affect oxygenation levels (O) 1 hour after treatment (T)?
  • In hospitalized children (P), how does double-checking pediatric medications with a second nurse (I) compared to not double-checking (C) affect medication errors (O) during a 30-day time period (T)?

In addition to intervention or treatment questions, other types of PICOT questions include meaning questions, diagnosis questions, etiology questions, andprognosis questions that are addressed in Chapter 3.

Step #2: Search for and collect the most relevant best evidence
After the clinical question is placed in PICOT format with the proper template, each keyword in the PICOT question should be used to systematically searchfor the best evidence; this strategy is referred to as keyword searching. For example, to gather the evidence to answer the intervention PICOTquestions in Step #1, you would first search databases for systematic reviews and randomized controlled trials given that they are the strongest levels ofevidence to guide practice decisions.

However, the search should extend to include all evidence that answers the clinical question. Each keyword or phrase from the PICOT question (e.g.,depressed adolescents, Prozac, Zoloft, depressive symptoms) should be entered individually and searched. Searching controlled vocabulary that matches thekeywords is the next step in a systematic approach to searching.

In the final step, combine each keyword and controlled vocabulary previously searched, which typically yields a small number of studies that should answerthe PICOT question. This systematic approach to searching for evidence typically yields a small number of studies to answer the clinical question versus aless systematic approach, which usually produces a large number of irrelevant studies. More specific information about searching is covered in Chapter 4.

Step #3: Critically appraise the evidence
After relevant evidence has been found, critical appraisal begins. First, it is important to conduct a rapid critical appraisal (RCA) of each study fromthe data search to determine whether they are keeper studies: that is, they indeed answer the clinical question. This process includes answeringthe following questions:

  • Are the results of the study valid? Did the researchers use the best methods to conduct the study (study validity)? For example, assessment of a study’s validity determines whether the methods used to conduct the study were rigorous.
  • What are the results? Do the results matter, and can I get similar results in my practice (study reliability)?
  • Will the results help me in caring for my patients? Is the treatment feasible to use with my patients (study applicability)?

Rapid critical appraisal checklists can assist clinicians in evaluating validity, reliability, and applicability of a study in a time-efficient way. SeeChapter 5 for one example of an RCA checklist for randomized controlled trials and Melnyk & Fineout-Overholt (2015) for a variety of RCA checklists.After an RCA is completed on each study and found to be a keeper, it is included in the evaluation and synthesis of the body evidence to determine whethera practice change should be made. Chapter 5 contains more information on critically appraising, evaluating, and synthesizing evidence.

Step #4: Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change
After the body of evidence from the search is critically appraised, evaluated, and synthesized, it should be integrated with a clinician’s expertise andalso a patient’s preferences and values to determine whether the practice change should be conducted. Providing the patient with evidence-based informationand involving him or her in the decision regarding whether he or she should receive a certain intervention is an important step in EBP. To facilitategreater involvement of patients in making decisions about their care in collaboration with healthcare providers, there has been an accelerated movement increating and testing patient-decision support tools, which provide evidence-based information in a relatable understandable format (Elwyn et al., 2015).

Step #5: Evaluate outcomes of the practice decision or change based on evidence
After making a practice change based on the best evidence, it is critical to evaluate outcomes—the consequences of an intervention or treatment. Forexample, an outcome of providing a baby with a pacifier might be a decrease in crying. Outcomes evaluation is essential to determine the impact of thepractice changes on healthcare quality and health outcomes. It is important to target “so-what” outcomes that the current healthcare system considersimportant, such as complication rates, length of stay, rehospitalization rates, and costs given that hospitals are currently being reimbursed based ontheir performance on these outcomes (Melnyk & Morrison-Beedy, 2012). A more thorough discussion of approaches to outcomes evaluation is included inChapter 7.

Step #6: Disseminate the outcomes of the EBP decision or change
Silos often exist, even within the same healthcare organization. So that others can benefit from the positive changes resulting from EBP, it is importantto disseminate the findings. Various avenues for dissemination include institutional EBP rounds; poster and podium presentations at local, regional, andnational conferences; and publications. More detailed information about disseminating outcomes of EBP is included in Chapter 9.

Rationale for the new EBP competencies

To accelerate the uptake of EBP and ensure that nurses are competent in the delivery of evidence-based care, a new set of EBP competencies was recentlydeveloped for practicing RNs and APNs. Competencies are typically developed and used to ensure the delivery of high-quality, safe nursing care, whichshould be an expectation from the public (American Nurses Association, 2010; Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). The process ofdeveloping these competencies along with the research conducted to further validate them are described in Chapter 2.

Summary

This chapter discussed how evidence-based practice (EBP) improves healthcare quality, patient outcomes, and cost reductions, yet multiple barriers persistin healthcare settings that need to be rapidly overcome. Ensuring that clinicians meet the newly established EBP competencies along with creating culturesand environments that support EBP are key strategies to transform the current state of nursing practice and healthcare delivery to its highest level. Thischapter discussed how evidence-based practice (EBP) improves healthcare quality, patient outcomes, and cost reductions, yet multiple barriers persist inhealthcare settings that need to be rapidly overcome. Ensuring that clinicians meet the newly established EBP competencies along with creating cultures andenvironments that support EBP are key strategies to transform the current state of nursing practice and healthcare delivery to its highest level.

(Video) The Six Dimensions of Healthcare Quality

Information on purchasing Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare.

References
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd edition). Silver Spring, MD: American Nurses Association.

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759–769.

Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12, 573–576.

Elwyn, G., Quinlan, C., Mulley, A., Agoritsas, T., Vandik, P. O., & Guyatt, G. (2015). Trustworthy guidelines—excellent; customized care tools—evenbetter. BioMed Central Medicine, 13(1), 199. Modified from Guyatt, G., & Rennie, D. (2002), Users’ guides to the medical literature.Chicago, IL: American Medical Association.

Harris, R. P., Hefland, M., Woolf, S. H., Lohr, K. N., Mulrow, C. D., Teutsch, S. M., & Atkins, D. (2001). Current methods of the U.S. PreventiveServices Task Force: A review of the process. American Journal of Preventive Medicine, 20, 21–35.

Magers, T. (2013). Using evidence-based practice to reduce catheter-associated urinary tract infections. American Journal of Nursing, 113(6),34–42.

Magers, T. L. (2015). Using evidence-based practice to reduce catheter-associated urinary tract infections in a long-term acute care facility. In B. M.Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare. A guide to best practice (3rd ed.) (pp. 70–73).Philadelphia, PA: Wolters Kluwer.

McGinty, J., & Anderson, G. (2008). Predictors of physician compliance with American Heart Association guidelines for acute myocardial infarction. Critical Care Nursing Quarterly, 31(2), 161–172.

Melnyk, B. M. (2014). Building cultures and environments that facilitate clinician behavior change to evidence-based practice: What works? Worldviews on Evidence-Based Nursing, 11(2), 79–80.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare. A guide to best practice (pp. 1–24).Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare. A guide to best practice (3rd ed.) (pp.3–23). Philadelphia, PA: Wolters Kluwer.

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012a). The state of evidence-based practice in US nurses: Critical implicationsfor nurse leaders and educators. Journal of Nursing Administration, 42(9), 410–417.

(Video) Improving Healthcare Quality and Safety with Dr. Nathan Spell

Melnyk, B. M., Grossman, D., Chou, R., Mabry-Hernandez, I., Nicholson, W., Dewitt, T.G. . . . & Flores, G. (2012b). USPSTF perspective onevidence-based preventive recommendations for children. Pediatrics, 130(2), e399–e407.

Melnyk, B. M., & Feinstein, N. (2009). Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parentsand premature infants: An analysis of direct healthcare neonatal intensive care unit costs and savings. Nursing Administrative Quarterly, 33(1),32–37.

Melnyk, B. M., Feinstein, N. F., Alpert-Gillis, L., Fairbanks, E., Crean, H. F., Sinkin, R., & Gross, S. J. (2006). Reducing premature infants’ lengthof stay and improving parents’ mental health outcomes with the COPE NICU program: A randomized clinical trial. Pediatrics, 118(5), e1414–e1427.

Melnyk, B. M., Gallagher-Ford, L., Thomas, B. K., Troseth, M., Wyngarden, K., & Szalacha, L. (2016). A study of chief nurse executives indicates lowprioritization of evidence-based practice and shortcomings in hospital performance metrics across the United States. Worldviews on Evidence-Based Nursing, 13(1), 6–14.

Melnyk, B. M., Gallagher-Ford, L., Long, L., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicingnurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5–15.

Melnyk, B. M., & Morrison-Beedy, D. (2012). Setting the stage for intervention research: The “so what,” “what exists” and “what’s next” factors. In B.M. Melnyk & D. Morrison-Beedy (Eds.), Designing, conducting, analyzing and funding intervention research. A practical guide for success (pp.1–9). New York, NY: Springer Publishing Company.

Pravikoff, D. S., Pierce, S. T., & Tanner A. (2005). Evidence-based practice readiness study supported by academy nursing informatics expert panel. Nursing Outlook, 53(1), 49–50.

Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM. London, UK: Churchill Livingstone.

Strout, T. D. (2005). Curiosity and reflective thinking: Renewal of the spirit. In Clinical scholars at the bedside: An EBP mentorship model for today[electronic version]. Excellence in Nursing Knowledge. Indianapolis, IN: Sigma Theta Tau International.

Titler, M. G. (2009). Developing an evidence-based practice. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (7th ed.) (pp. 385–437). St Louis, MO: Mosby.

Book authors:
Bernadette Mazurek Melnyk,PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, is associate vice president for health promotion, university chief wellness officer, and professor and dean of the College of Nursing at The Ohio State University. She also is professor of pediatrics and professor of psychiatry at Ohio State’s College of Medicine.

Lynn Gallagher-Ford, PhD, RN, DPFNAP, NE-BC,is director of the Center for Transdisciplinary Evidence-based Practice (CTEP) and clinical associate professor in the College of Nursing at The Ohio State University.

(Video) Evidence-Based Practice Methodology

Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN,is the Mary Coulter Dowdy Distinguished Nursing Professor in the College of Nursing & Health Sciences at the University of Texas at Tyler.

FAQs

How does evidence-based practice improve care and patient outcomes? ›

The intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care, which is known to produce unpredictable health outcomes. Development of evidence-based practice is fueled by the increasing public and professional demand for accountability in ...

How does evidence-based practice improve healthcare costs? ›

Evidence-Based Practice Reduces Costs and Streamlines Care

Evidence-based practices put into real-life application have been found to decrease costs for patients and institutions by standardizing and streamlining care and significantly decrease the likelihood of unnecessary procedures.

Does evidence-based practice improve outcomes? ›

Evidence-based practice (EBP) prevents unsafe/inefficient practices and improves healthcare quality, but its implementation is challenging due to research and practice gaps.

How can evidence-based practice improve patient quality and safety? ›

Utilizing EBP promotes more of a collaborative approach to care. When all providers are basing their care on the latest evidence, variation of care is reduced. Add provider communication to this mix, and a recipe for quality care and improved patient safety is created.

What is the benefit of evidence-based practice in healthcare? ›

Why is Evidence-Based Practice Important? EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence.

What are the benefits of evidence-based practice for patients? ›

Advantages of evidence-based practice include the ability to evolve and individualize care of patients, reduce cost of patient care, and enhance the expertise of the medical professional providing your care.

How does evidence-based medicine reduce costs? ›

One way in which EBM can help reduce the costs of cancer care is by optimizing the appropriate use of less expensive drugs. When pathways are developed, it will often be found that evidence supports the use of less expensive therapies, without compromising outcomes or increasing toxicity.

What are the top three most important aspects of evidence-based practice? ›

Evidence-based practice includes the integration of best available evidence, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision making. All three elements are equally important.

How can evidence-based medicine improve patient experience? ›

Evidence-based practice (EBP) strategies that have positive impact on patient perceptions of their ED care and increased satisfaction ratings include AIDET, Hourly Rounding, and Bedside Shift Report, which incorporate updates of test results and explanations of events occurring during a patient's visit.

What are two 2 advantages to using evidence based management? ›

A decision-making process that relies on a structured and quality-oriented approach increases transparency and therefore accountability. As a result, you will not just increase organizational performance but also your standing, reputation, and career perspectives as a manager and professional.

What are key strategies to improve quality care utilizing evidence-based practice? ›

The 4 keys to implementing evidence-based practices
  • Understand the data. ...
  • Consider your resources. ...
  • Establish patient-centered goals. ...
  • Identify your preferences.
Sep 10, 2019

What is evidence-based quality improvement? ›

Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations.

What is the relationship between evidence-based practice and quality improvement? ›

While evidence-based medicine justifies clinical decisions with evidence, quality improvement is 'translational'; putting evidence-based medicine into practice in healthcare systems and grappling with incentives in healthcare, whether they are non-financial, reputational or financial.

What are the 4 components of evidence-based health care? ›

Evidence-based medicine (EBM) follows four steps: formulate a clear clinical questions from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice.

What are three ways to reduce health care costs? ›

Eight ways to cut your health care costs
  1. Save Money on Medicines. ...
  2. Use Your Benefits. ...
  3. Plan Ahead for Urgent and Emergency Care. ...
  4. Ask About Outpatient Facilities. ...
  5. Choose In-Network Health Care Providers. ...
  6. Take Care of Your Health. ...
  7. Choose a Health Plan That is Right for You.
Aug 11, 2022

What are three factors that impact the costs of healthcare? ›

A Journal of the American Medical Association (JAMA) study found five factors that affect the cost of healthcare: a growing population, aging seniors, disease prevalence or incidence, medical service utilization, and service price and intensity.

What are the 5 A's of evidence-based practice? ›

We therefore advocate to be more explicit and aim to clarify the distinction between EBP for the individual patient and for a group of patients or caregivers by discussing the following five steps: ask, acquire, appraise, apply and assess [4].

What are the 4 pillars of evidence-based practice? ›

Evidence-based practice: 'involves using clinical reasoning to integrate information from four sources: clinical expertise, research evidence, the patient's values and circumstances, and the practice context.

What are the 5 models of evidence-based practice? ›

Evidence-based practice is a process that involves five distinct steps which we call the five 'A's: Ask, Access, Appraise, Apply, Audit.

How can we improve the quality of patient care? ›

8 Healthcare Quality Improvement Tips
  1. 1) Analyze your data and outcomes. ...
  2. 2) Set goals. ...
  3. 3) Create a balanced team. ...
  4. 4) Include Human Factors Inputs. ...
  5. 5) Create an executable plan. ...
  6. 6) Become Familiar with the PDSA cycle. ...
  7. 7) Communicate goals and progress. ...
  8. 8) Research other organizations and collaborate.
Feb 18, 2016

What are examples of evidence-based strategies? ›

An example of this includes questions such as, “What do you think you will really use?” and “What do you expect to learn from this lesson?” Applying retrieval strategies, using background knowledge, and activating prior learning. This helps assess where teachers need to begin instruction, reteach, and review.

What are the three goals of EBP? ›

The goal of EBP is to "improve the quality, effectiveness, and appropriateness of health care by synthesizing the evidence and facilitating the translation of evidence-based research findings," according to Agency for Healthcare Research and Quality (AHRQ).

What are the challenges of evidence-based practice? ›

However, unreliable evidence, lack of knowledge and skill, time mismanagement, lack of motivation, the decision to adopt and implement an innovation made by higher up in the hierarchy than the innovation's target users and lack of commitment are the challenges of implementation of evidence-based practice.

What are the most effective ways to come to an evidence-based solution? ›

5 steps of Evidence Based Practice
  • Ask a question. ...
  • Find information/evidence to answer question. ...
  • Critically appraise the information/evidence. ...
  • Integrate appraised evidence with own clinical expertise and patient's preferences. ...
  • Evaluate.

Which strategies promote evidence-based practice? ›

Implementation strategies for promoting EBP fall into seven general categories: leadership, coaching, communication, rein- forcements, recognition, measurement, and reporting. Different strategies may be appropriate at each stage of change.

What are the 5 P's in quality improvement? ›

The microsystem concept is an organizational framework for providing and improving care by making explicit the “5 Ps”—purpose, patients, professionals, processes, and patterns (table 2​).

What are the 3 types of measures for quality improvement? ›

Three Types of Measures

Use a balanced set of measures for all improvement efforts: outcomes measures, process measures, and balancing measures.

What is the relationship between evidence-based practice and health care quality? ›

To significantly influence the improvement of quality in healthcare, there is a need to apply evidence-based practice (EBP). Without EBP, healthcare providers are at risk for variances in care that could seriously affect patient outcomes [11].

How can evidence-based practice be used to improve nursing? ›

The 4 keys to implementing evidence-based practices
  1. Understand the data. ...
  2. Consider your resources. ...
  3. Establish patient-centered goals. ...
  4. Identify your preferences.
Sep 10, 2019

How does evidence-based practice improve work life of healthcare providers? ›

EBP can help save time and resources by using proven strategies and treatments. Because it streamlines the approach and gives healthcare providers resources and information to guide difficult decisions, evidence-based practice can also help with nursing burnout, which is common among healthcare staff.

What is evidence-based practice how does it benefit nursing practice and patient care? ›

Evidence-based practice in nursing is an approach to patient care that uses problem-solving, research and clinical expertise to plan treatment. Evidence-based practice is unique in the way it involves patients and requires nurses to consider each patient's preferences.

What are two key concepts that are important in evidence-based nursing practices? ›

Strong clinical reasoning and decision-making skills and research competency are essential components needed to understand and implement EBP in nursing.

What is evidence-based practice in quality care? ›

EBP is defined as a systematic method of evaluating the best available scientific evidence from studies and clinical experience, including patient interests, beliefs, expectations, and needs to make a clinical decision that will affect patient care in particular circumstances [5, 6].

What are the 4 major components of evidence based nursing? ›

Evidence-based medicine (EBM) follows four steps: formulate a clear clinical questions from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice.

Videos

1. Evidence-Based Practice: Improving Practice, Improving Outcomes (Part Two)
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2. Quality Improvement in Healthcare
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3. "Evidence-Based Practice" by Bernadette Melnyk for OPENPediatrics
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4. Improving health outcomes with big data | Ronda Hughes | TEDxUofSC
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5. Intro to Nursing Research & Evidence Based Practice
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6. Improving Patient Outcomes rev 9 3 2019 Voiceover
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