Evidence-Based Cost Effective Quality Care
Introduction
Evidence-based practice (EBP) is a concept that applies evidence for making clinical decisions that are mostly practised in the healthcare system. Critical thinking and reflection are essential elements of EBP. However, people against EBP negate the practitioners’ contribution and misrepresent the whole idea of EBP in a clinical setup. The process of EBP involves the collection, analyzing, interpretation, and evaluating evidence obtained from the daily activities in a clinic. The data could be gained through observation of patients by clinicians, records from clients and also from empirical research. Practitioner expertise is a critical aspect of EBP decision making, especially in modern days. Interest in knowledge in several fields has increased. EBP has been employed in social work which requires a given thinking process. EBP practice has had an impact on costs and quality of care provided in healthcare facilities. The purpose of this paper is to analyze the effect of clinical reasoning and decision making concerning costs, EBP, and quality improvement in a healthcare system. An appraisal of how social determinants, indicators, and benchmarks have impacted decision making in telehealth implementation in the African American community will also be explained.
Models of Evidence-Based Practice
There are several models of EBP that have already been put into practice in healthcare facilities. These models use similar concepts in the decision-making process. Some of the elements applicable to all models include; selection of a topic of interest, collection information, processing of evidence, implementation of the results, and evaluation of the outcome. A lot of learning is involved in from synthesizing evidence and putting it into practice and feedback issued in the process forms the basis of improvement. The most recent model developed by the Agency for Healthcare Research and Quality (AHRQ) research committee is a concept of fully utilizing the transfer of result from the agency to a safe portfolio developed for patients. The model involves a series of ideas which requires expert knowledge in data transfer, social promotion, innovation, and behavioural changes. Despite the model involving several stages, knowledge transfer is, however, not a simple process. Still, a complex task that requires different expertise and EBP implementation form the basis of its success.
Decision-Making Process in EBP
There are five steps, followed by medical practitioners’ expertise in making optimal decisions. Decision making requires the involvement of a specific set of skills that are critical to practitioner expertise to determine the course of action to take in given scenarios. First, a question to be answered by information is formulated by the practitioner. The item must, however, be answered from the information to be collected or available. Secondly, evidence to answer the question above is gathered and managed, and the most appropriate is set aside for the next step. Thirdly, the evidence obtained is critically analyzed to ensure that it is viable with the information needed to answer the formulated question. Fourth, an integration appraisal with a colleague is conducted to examine its value to patients and the results obtained are put into practice in the healthcare facilities. Lastly, the outcome of the decision made is evaluated and measured to determine its impact (Skaggs et al., 2018). The steps are seen from researchers perspectives, users of information, and those who bridge the gap between researchers and users.
For instance, the steps used in the AHRQ model discussed above are creation and distillation of knowledge, dissemination of experience, and implementation of the results. The above steps are viewed from the researchers’ perspective from identifying the findings from patients’ databases that ought to be transferred. Knowledge creation and distillation are carrying out research and then put relevant results into actionable products for specific recommendations. In a care setup, this process is conducted by knowledgeable people to ensure implementation is based on proper evidence (Skaggs et al., 2018). In diffusion and dissemination, the practitioners collaborate with other experts and leaders to disseminate knowledge ready for action. Link researchers, together with other professional intermediaries, have facilitated for effective transfer of research-based knowledge targeting the right audience for the information with the intent to influence them to adopt the findings of the research. The end-user implementation is the last step of knowledge transfer whereby individuals and organizations choose the conclusions of the study conducted.
EBP and Costs
Several strategies are required during the implementation of research-based evidence in healthcare facilities which also affects the decision making process in a health care setup.EBPs have resulted in improved decision making in healthcare facilities. Also, EBP has brought significant impact in the adult learning process, health education, social factors, behaviour changes in organizations, and marketing, among other factors (Lang & Connell, 2017). EBP has enabled nurses to cut down the costs of healthcare by eliminating unnecessary prescriptions and treatment methods. For instance, a nurse may opt to prescribe generic medicines that are less expensive but effective compared to brand medicines that are highly expensive and work the same as generic. The burden of cost reduces to the patient hence increasing affordability of care by patients. Most of the nurses use critical thinking and come up with innovative ideas which are then backed up by research to determine viability. Implementations of these ideas require incorporation of management and quality leadership skills which involves a concept of budgeting and cost management in a healthcare facility (Lang & Connell, 2017). In most scenarios, nurses have a significant influence on the cost of healthcare in the facilities they work in because they are the face of the facility. Implementation of EBP by nurses has enabled healthcare facilities to cut down on costs by eliminating certain supplies and projects that are not necessary for the delivery of care services.
Additionally, the implementation of EBP by nurses has impacted the healthcare costs is advocating for the removal of treatments and medications that are not needed by patients. For example, physicians would be efficient if they use the records taken by nurses while examining patients rather than conducting afresh in diagnostic. Clinicians, therefore, play a critical role in influencing cost efficiency in their organizations (Manning &DiLollo, 2017). In a primary care setup, nurses can reduce costs by avoiding repetitive care services that would result in extra expenses to patients such as vaccines administration and ultrasounds already done in other facilities. Nurses, in this case, can use the already available records and images to determine the best treatment for the patients as opposed to re-examining the patient, which would result in double charges. Adoption of EBPs by nurses have made them valuable assets in the healthcare system as they not only give care to patients but also give insight on how to enhance cost efficiency by eliminating waste.
EBP and Quality Care
Nurses with the help of evidence-based practice have the ability and capacity to provide high-quality care of services which generally improves the outcome of patients. Also, EBP has enabled the nurses to smoothly run healthcare facilities to increase efficiency and satisfaction of patients. Nurses adopt EBP by reflecting, analyzing care, and always have information on new knowledge that would aid in improving the quality of care services. Provision of cost-efficient services has reduced the cost of care to patients and also has led to enhanced and improved care given to patients. The most significant reason why EBP has improved quality is due to the aspect of incorporating patients to participate in decision making about their care and treatment. For the mentioned reason, patients are satisfied by the attention, and the nurses also can give care based on the need of the patients. The partnership between patient and nurses increases the satisfaction to both patients and nurses hence improving the quality of healthcare service (Skaggs et al., 2018). EBP is a problem-solving approach that identifies the gaps in the quality of care and then finds a solution to bridge the gap by use of research as evidence.The problem-solving approach enables the nurses to coordinate clinician expertise and patients to come up with the possible strategy to deal with patients at an individual level.
Leadership Skills and EBP
Changes are inevitable in healthcare organizations if nurses are to create a conducive environment in which patients can receive quality services and enhance safety.For these changes to happen, leadership skills are required to establish a framework that will transform the environment, which includes people in the management of the healthcare facilities (Harvey et al.,2020). Some of the leadership skills required by nurses to implement EBP add; ability to balance efficiency and safety, ability promote trust in the facility, ability to monitor and manage changes, ability to involve other workers in the decision making, and ability to use the knowledge obtained to create a learning organization. These leadership skills and management practices contribute to the success of adopting EBPs in an organization. Nurses who possess transformational leadership can implement EBP to bring about changes in healthcare services that will increase the level of satisfaction to patients.
EBP, Social System, Indicators, and Benchmarks
Implementation of EBPs considers the social system, indicators and benchmarks, which determines the effectiveness of the practice. For instance, while researching urinary inconsistency, the efficacy of the research was more demonstrated when patients were relocated to a nursing home because of the consistency of intervention by care providers as opposed to the patient being at their homes. Several social factors influence the implementation of EBPs such as the number of patients a physician should attend, the size of the healthcare facility, and the location of the facility (Daniel, Bornstein & Kane, 2018). Larger organizations are at an advantage of innovation adoption due to their size. Implementing EBP should consider a social system such as policies, procedures, and documentation process. The project of telehealth improvement in the African American community has adopted EBP through research-based evidence that has shown that the community receives low-quality care due to social factors such as lack of better hospitals and also culture. Therefore, EBP has aided in identifying gaps in healthcare facilities that need to be bridged and thus the need for telehealth which cut down on cost and increase access to quality care.
Conclusion
Evidence-based practice has generally led to an increase in the quality of healthcare services and a reduction in the cost of care in healthcare facilities. Research is conducted based on the need, and evidence is analyzed to come up with the most viable solution that is implemented. Nurses play a significant role in the implementation of EBP, and their leadership skills have led to the success of the practice. EBP increases satisfaction to both the nurses and patients, which translates to improved quality and cost reduction of care to patients.
References
Daniel, H., Bornstein, S. S., & Kane, G. C. (2018). Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Annals of internal medicine, 168(8), 577-578.
Harvey, G., Kelly, J., Kitson, A., Thornton, K., & Owen, V. (2020). Leadership for evidence-based practice—Enforcing or enabling implementation?. Collegian, 27(1), 57-62.
Lang, J. M., & Connell, C. M. (2017). Measuring costs to community-based agencies for implementation of evidence-based practice. The journal of behavioural health services & research, 44(1), 122-134.
Manning, W. H., &DiLollo, A. (2017). Clinical decision making in fluency disorders.Plural Publishing.
Skaggs, M. K. D., Daniels, J. F., Hodge, A. J., &DeCamp, V. L. (2018). Using the evidence-based practice service nursing bundle to increase patient satisfaction. Journal of Emergency Nursing, 44(1), 37-45.