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Ward School of Health Sciences
Health Series: Research Spotlight

Evidence-based practice saves lives and shortens hospital stays

Research suggests that evidence-based practice (EBP) improves patient outcomes and saves lives

by George Wigmore (Senior Communications Officer)

A new paper by researchers from City University London and clinicians in Spain suggests that evidence-based practice (EBP) improves patient outcomes and saves lives.

The study, which is published in the journal of Journal of Evaluation in Clinical Practice, also showed that physicians who deliberately reorganised their service to provide evidence-based care delivered more efficient care as their patients had shorter lengths of stay in hospital than other patients yet no higher re-admission rates. Evidence-based doctors attended twice as many patients per doctor as standard care doctors.

Although evidence‑based practice (EBP) is increasingly promoted, many health services and health practitioners continue to provide care in the standard way. This may be because they many do not believe that deliberate EBP produces better outcomes than standard care.

 Ward School of Health SciencesThis new research is an analysis of a natural experiment that occurred when part of the internal medicine service in a Basque hospital was reorganised in 2003 to form an EBP unit with the rest of the service remaining unchanged. The unit attended similar patients to the rest of the service until 2012 permitting their outcomes and activity to be compared. The study found that the EBP physicians’ patients had better outcomes and their service was more efficient than standard practice physicians’.

The authors used routinely collected statistics from 2004 and 2011 to compare the outcomes from the different methods of practice and test whether patients being seen by the EBP unit differed from standard practice (SP) patients. To exclude pre-existing differences between the EBP and SP doctors, that might account for the better results achieved by the physicians adopting EBP, data from 2000‑2003 (prior to creation of the EBP unit) were used to compare their performance with other doctors. There were no statistically significant differences between the doctors’ performance prior to the establishment of the EBP unit.

Following the unit’s establishment, the mortality of patients being treated by EBP doctors, compared to their previous performance, dropped from 7.4% to 6.3% and length of stay from 9.15 to 6.01 days. No statistically significant improvements were seen in the other physicians’ performance.

EBP patients had a clinically and statistically significantly lower risk of death than contemporaneous standard practice patients (6.27% compared to 7.75%) and a shorter length of stay (6.01 to 8.46 days). The researchers established that there were no differences in the proportion of patients admitted or their complexity between the services that might account for the observed difference in performance.

Speaking about the research, Amanda Burls, Professor of Public Health in School of Health Sciences at City University London and co-author of the paper, said:

“Our research on the outcomes of patients after the establishment of an evidence-based practice unit showed that, not only did EBP doctors attend twice as many patients as other doctors, but, more importantly, their patients were less likely to die and did not need to be in hospital as long as other similar patients.

“In these days, where efficiency savings for the NHS are being sought, managers should provide training in evidence-based health care and easy access to information systems required for its practice and work to promote organizational and cultural change to support evidence-based practice. Clinicians who want the best outcomes for their patients should seek training in evidence-based health care and work collaboratively with colleagues to ensure their decisions are informed by the best available evidence”

Sir Muir Gray, the NHS’s first Chief Knowledge Officer, and Director of Better Value Health Care commented on the study:

“This study emphasises the importance of evidence-based decision making for both individuals and organisations. We need to move away from the idea that clinical practice and management are two completely distinct activites. Healthcare is a knowledge business and decisions of all types need to be based on knowledge from research - the type of knowledge we call evidence.”

Idoia Gurrutxaga, Medical Director of the hospital where the EBP unit was set up commented about the findings:

“The health sector derives its main value from human resources (who have a high level of vocation and commitment and work in a highly professional setting) and in the extensive knowledge they harbour.

“The results of this study confirm that investing in human resources and knowledge yields significant benefits for the people we serve. There are few technological or therapeutic investments which, at similar cost, could have generated such powerful effects on health in such a short time.

"Implementing evidence-based care changed the way our health professionals work and changed the how health care was organized. The support given to other teams from this small EBP group meant that these changes have propagated over time to other colleagues spreading the beneficial effect to other areas. It is our endeavour to further consolidate this change by allowing and encouraging the development of other teams trained in this way of working.”

The doctors who initially set up the EBP unit commented:

Dr Kepa Aranegi: “Training in evidence-based medicine made me feel more comfortable in the management of uncertainty in diagnosis, treatment and prognosis of my patients’ conditions. It also proved to be a useful tool when planning teamwork and helped unify criteria within our service for the achievement of common goals.”

Dr Joxe Artetxe: “Evidence-based medicine allowed me to move the best existing knowledge to the bedside or consulting room in real time, adapting this knowledge to the specific characteristics of my patients. Evidence-based medicine also allowed me to quantify uncertainty in such a way that, now, I feel it is an indispensable tool for making clinical decisions.”

Definition
Evidence-Based Practice (EBP)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care

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