christopher manacci, msn, acnp, ccrn acute care nurse practitioner critical care transport services...

Christopher Manacci, MSN, ACNP, CCRNAcute Care Nurse Practitioner

Critical Care Transport ServicesThe Cleveland Clinic

Director, ACNP Flight Nursing ProgramThe National Flight Nurse Academy

Case Western Reserve University

Define EBP Discuss the process for developing EBP Identify levels of evidence Discuss how to evaluate evidence List strategies for making EBP changes

Integration of best research evidence with clinical expertise and patient values

◦ Identify a clinical problem◦ Asking an answerable question◦ Searching for evidence◦ Evaluating evidence

Clinical practice – high volume, high cost patient populations

Quality assurance indicators Regulatory requirements, accreditation

standards

Strong questions have 4 components:• Problem of interest• Main intervention• Comparison intervention, if relevant• Outcome of interest

Searching for evidence Start with Systematic Reviews Clinical trials Experimental studies Quasi experimental studies Descriptive or Qualitative Case Studies

Systematic review is a summary of research literature that uses explicit methods to systematically search, critically appraise, and synthesize the literature on a specific issue.

◦ Meta-analysis – a type of systematic review that uses quantitative methods to summarize the results.

Clinical Trial:◦ random assignment of subjects◦ double blinded◦ prospective ◦ one or more interventions are tested in an

experimental group and compared to a control group

Experimental study has:◦ Random assignment of subjects to an

experimental and control group◦ An independent variable that the investigator

manipulates (intervention)◦ A dependent (outcome) variable

Quasi-experimental has:◦No Random assignment of subjects to an

experimental and control group◦ An independent variable that the investigator

manipulates (intervention)◦ A dependent (outcome) variable

Descriptive, Correlational, Survey:◦ Main objective is to understand the characteristics

of persons, situations, or groups; and/or the frequency with which certain phenomena occur.

Qualitative:◦ Main objective is to describe a phenomenon or

understand an experience◦ Data is collected in narrative (nonnumeric) form

Case Study:◦ An in-depth analysis of an individual, group,

institution or other social unit

National Guideline Clearinghouse◦ www.ngc.gov

The Cochrane Library◦ www.chchrane.de

Evidence Based Journals◦ e.g. www.evidencebasednursing.com

Professional Organization Guidelines PubMed

◦ www.ncbi.nlm.nih.gov/PubMed

Systematic Reviews (SR): Are the results of the SR valid? Are the results important? Can you apply this evidence in caring for

your patients? What is the clinical bottom line?

The Association of Air Medical Services Research Committee developed several surveys

Identify the restraining forces related to the lack of research

Identify the priorities in air medical research Develop a cohort of member programs to

create, encourage and promote research

Auto Launch Early Activation Appropriate use of air medical services Criteria for waiting on scene for air

medical services Relationship of number and type of

missions and patient outcomes Is there a difference in outcome utilizing

different team configurations, e.g. Advanced Practice v. Traditional

What is auto launch and do we all define it the same way?

Is auto launch different than early activation?

Is auto launch cost effective? Does auto launch improve outcomes in the

trauma population?