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; and
Support staff to use the best available evidence and relevant clinical care standards in their provision of care.
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 2018).
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?
Staff should have access to resources that reflect best practice-evidence. These may be in the form of:
Integrated care pathways;
Decision support tools; and
Clinical care standards.
The Hierarchy of Evidence
Some types of research are considered more reliable than others. The following hierarchy lists types of research from most to least reliable.
While Level I evidence is the best option, it is not always available. In that case, you should move down to Level II and try again. If you are still unable to find anything suitable, keep moving down the list until you are successful (Turner 2014).
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 several kinds of specific questions. View it here.
Systematic review of Level II studies
Randomised controlled trial
Pseudorandomised controlled trial
Comparative study with concurrent controls:
Non-randomised, experimental trial
Interrupted time series with a control group
Comparative study without concurrent controls:
Historical control study
Two or more single arm study
Interrupted time series without a parallel control group
Case studies with either post-test or pre-test/post-test
(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.
Identify the need for information.
Convert this into a well-built, answerable clinical question that is:
Directly relevant to the issue you have identified; and
Worded in a way that can help yield a precise answer.
Determine a search strategy.
Use the hierarchy of evidence to gather evidence.
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?
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?
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?
Supporting Evidence-based Care
In order to support staff to deliver evidence-based care, health service organisations should:
Utilise clinical care standards;
Hold 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; and
Conduct audits to determine what proportion of carer is adhering to evidence-based resources.
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.
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