Evidence-based Care

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Published: 24 July 2023

About 40% of adult patients are provided care that isn’t based on current evidence. Some of this care is ineffective, unnecessary and potentially even harmful (Health.vic 2021).

Evidence-based care is a key component of effective and multidimensional care provision. So, how can it be implemented?

What is Evidence-based Care?

Evidence-based care (also known as evidence-based practice) is the use of research evidence, in tandem with clinical expertise and patient values, to inform clinical decisions (Health.vic 2021).

Specifically, evidence-based care is an integration of:

  1. Best available research evidence
  2. Staff skills, training and experience (clinical expertise)
  3. The patient’s values and circumstances (e.g. financial situation)
  4. The practice context in which healthcare staff are working.

(Turner 2023)

What Are the Benefits of Evidence-based Care?

  • Improved patient outcomes
  • Improved quality of life for patients
  • Staff are encouraged to reflect upon whether they can perform tasks more effectively
  • Improved allocation of resources
  • Improved staff productivity
  • Reduced costs
  • Staff can stay updated about new protocols
  • Patients can participate in their care by voicing their concerns, values and preferences.

(Turner 2023; Health.vic 2021; ANA 2023)

nurse with happy patient

Evidence-based Care in the National Safety and Quality Health Service Standards

Evidence-based care is outlined in Action 1.27 of the National Safety and Quality Health Service Standards, under Standard 1: Clinical Governance.

This action aims to ensure healthcare workers use the best available evidence in their practice. Health service organisations should:

  • Allow staff to easily access best-practice guidelines, integrated care pathways, clinical pathways and decision support tools
  • Support staff to use the best available evidence in their provision of care, including clinical care standards developed by the Australian Commission on Safety and Quality in Health Care.

(ACSQHC 2022)

What is Best Available Research Evidence?

The term best available research evidence refers to ‘clinically relevant research drawn from studies with the least possible bias’. In other words, it is the highest-quality research available (CIAP 2019).

In order to determine whether research is of sufficient quality to inform your clinical decision-making, you must consider:

  • Validity: Is the research reliable?
  • Impact: Are the results of the research clinically significant?
  • Applicability: Is the research relevant and applicable to the patient and their situation?

(Turner 2023)

Staff should have access to resources that reflect best practice-evidence. These may be in the form of:

  • Best-practice guidelines
  • Integrated care pathways
  • Clinical pathways
  • Decision support tools
  • Clinical care standards.

(ACSQHC 2022)

The Hierarchy of Evidence

nurse researching on laptop

Some types of research are considered more reliable than others.

The most suitable type of evidence depends on the kind of question you are answering. For further advice, the National Health and Medical Research Council (NHRMC) has devised a detailed table listing evidence from most to least reliable for different kinds of research questions:

Level Intervention Diagnosis Prognosis Aetiology Screening
I Systematic review of Level II studies Systematic review of Level II studies Systematic review of Level II studies Systematic review of Level II studies Systematic review of Level II studies
II Randomised controlled trial Study of test accuracy with an independent, blinded comparison with a valid reference standard, among consecutive patients with a defined clinical presentation Prospective cohort study Prospective cohort study Randomised controlled trial
III-1 Pseudorandomised controlled trial Study of test accuracy with an independent, blinded comparison with a valid reference standard, among consecutive patients with a defined clinical presentation All or none All or none Pseudorandomised controlled trial
III-2 Comparative study with concurrent controls:
  • Non-randomised, experimental trial
  • Cohort study
  • Case-control study
  • Interrupted time series with a control group
Comparison with reference standard that does not meet the criteria required for Level II and III-1 Analysis of prognostic factors amongst untreated control patients in a randomised controlled trial Retrospective cohort study Comparative study with concurrent controls:
  • Non-randomised, experimental trial
  • Cohort study
  • Case-control study
III-3 Comparative study without concurrent controls:
  • Historical control study
  • Two or more single arm study
  • Interrupted time series without a parallel control group
Diagnostic case-control study Retrospective cohort study Case-control study Comparative study without concurrent controls:
  • Historical control study
  • Two or more single arm study
IV Case studies with either post-test or pre-test/post-test Study of diagnostic yield (no reference standard) Case series, or cohort study of patients at different stages of disease Crosssectional study Case studies

(Adapted from NHMRC 2009)

The 5 Steps of Evidence-based Care

The ‘5A’s Cycle’ (ask, acquire, appraise, apply and audit) is the model used to incorporate evidence into practice.

1 Ask
  • Identify the need for information.
  • Convert this into a well-built, answerable clinical question that is:
    • Directly relevant to the issue you have identified
    • Worded in a way that can help yield a precise answer.
2 Acquire
  • Determine a search strategy.
  • Use the hierarchy of evidence to gather evidence.
3 Appraise
  • Assess the evidence for validity, impact and applicability using the following questions:
    • Why was the study performed?
    • What type of study is it?
    • What are the characteristics of the study?
    • How did the study address and combat bias?
    • What are the results?
    • Are the results valid?
    • What conclusions can you draw from the study?
4 Apply
  • Decide whether to incorporate the evidence into clinical decision-making. If so, how will you do it?
  • Integrate the evidence with the other three elements of evidence-based care (clinical expertise, patient situation and practice context).
  • Consider the following:
    • Do the results of the study apply to your patient?
    • Were all clinically important outcomes considered?
    • Are the results clinically important?
    • Are the likely benefits of applying this evidence worth the possible harm or cost it could incur?
    • What are your patient’s values and preferences?
    • How can you help your patient make a decision?
5 Audit
  • Self-evaluate your performance throughout the evidence-based care process. Consider the following:
    • Did you ask a well-built answerable question?
    • Are you becoming more efficient and gathering the best available evidence?
    • Did you critically appraise the evidence?
    • Did you integrate critical appraisals into your practice?
    • Is what you have learned been translated into better clinical practice?

(Turner 2023)

Supporting Evidence-based Care

nurses discussing their practice

In order to support staff to deliver evidence-based care, health service organisations should:

  • Utilise clinical care standards
  • Hold healthcare staff accountable for their practice
  • Quickly identify and manage any harmful practices that are observed
  • Monitor compliance with and any deviations from evidence-based practice
  • Designate committees or individuals responsible for approving and reviewing resources based on best available evidence
  • Enable peer-based feedback about compliance with and deviation from evidence-based practice
  • Inform staff if an unwarranted deviation from evidence-based practice has been observed
  • Conduct audits to determine what proportion of carer is adhering to evidence-based resources.

(ACSQHC 2022)

Conclusion

By using clinical expertise, patient preferences and practice context to inform clinical decisions alongside the best, most reliable research available, you can ensure patients receive appropriate and high-quality care.

References


Test Your Knowledge

Question 1 of 3

Which component of evidence-based care would the funding situation of your health service organisation fall under?

Author

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