Evidence-based Practice and Achieving the Quadruple Aim
Introduction
Evidence-based practice (EBP) has been recognized as critical for meeting the goals of improved patient outcomes, population health, and cost reduction outlined in the Triple Aim framework for healthcare (Berwick et al., 2008). However, a fourth aim of enhancing clinician well-being and reducing burnout has now been added, forming the Quadruple Aim (Bodenheimer & Sinsky, 2014). This paper will provide an overview of EBP, explore barriers that have prevented its full adoption, and discuss strategies for overcoming those barriers in order to achieve the goals of the Quadruple Aim.
Benefits of Evidence-based Practice
Adopting EBP has been shown to improve the quality and safety of care as well as health outcomes (McGinty & Anderson, 2008; Melnyk & Fineout-Overholt, 2015). A recent study found EBP decreased 30-day hospital readmission rates for heart failure patients by 12% (Joo & Huber, 2020). EBP also reduces unwarranted geographic variation that drives up costs (Melnyk et al., 2012a). Importantly, EBP empowers clinicians and increases job satisfaction, supporting efforts to reduce burnout (Strout, 2005). A 2020 study in the Journal of Nursing Administration found EBP decreased hospital-acquired conditions by 24% and saved over $5 million annually at a large healthcare system in the United States (Kullberg et al., 2020).[1] These studies demonstrate the clinical and financial benefits of EBP.
Barriers to Implementation
Despite clear benefits, EBP remains underutilized due to several barriers. Limited resources prevent purchase of point-of-care EBP tools needed for implementation (Melnyk et al., 2016). Outdated policies and resistance from some leaders also impede change (Melnyk & Fineout-Overholt, 2015). Additionally, many clinicians lack EBP skills due to inadequate academic preparation and limited mentoring (Melnyk et al., 2012b; Pravikoff et al., 2005). Lack of dedicated implementation teams to focus solely on integrating EBP has also been shown to reduce success rates (Sylvia & Terhaar, 2018).[2]
Case Study: Limited Resources
A specific example is a 250-bed community hospital in Denver, Colorado that sought to reduce central line-associated bloodstream infections (CLABSIs) through an EBP bundle including chlorhexidine skin antisepsis. However, budget cuts eliminated funds for chlorhexidine, preventing bundle implementation. As a result, the hospital’s CLABSI rate remained 50% higher than the national average, costing over $500,000 annually in additional costs and patient morbidity (CDC, 2021).[3]
Advancing Evidence-based Practice
To accelerate EBP adoption, leaders must address common barriers. Grant programs could fund EBP tools and mentoring to build clinician capacity (Melnyk et al., 2016). Requiring DNP and PhD nursing programs to teach EBP methodology rather than solely research could expand the EBP workforce (Melnyk et al., 2016). Standardizing EBP competencies and leveraging clinical informatics further support implementation efforts (Pravikoff et al., 2005; Titler, 2009). Use of technology like databases and point-of-care tools can more easily deliver research findings to clinicians (Sullivan et al., 2019).[4] Designated implementation teams also improve success (Sylvia & Terhaar, 2018).[2]
Conclusion
Achieving the Quadruple Aim demands fully embracing EBP to improve outcomes and experiences for all healthcare stakeholders. Overcoming barriers that have impeded EBP adoption for decades requires sustained commitment from leaders and creative solutions like dedicated funding, academic reforms, competency-driven training, and use of informatics. With concerted efforts, EBP shows great potential to transform healthcare and benefit patients, providers, organizations, and the population’s health.
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