Translating evidence into practice : a case study on the prevention of venous thromboembolism using the Joanna Briggs Institute model of evidence-based health care

Getting the best available evidence into daily routine practice at the bedside is necessary to benefit patients and health care budgets. Easily understood and ready available synthesised evidence is not sufficient on its own, it also requires evidence-based knowledge translation strategies and interventions that take into consideration all levels and aspects within the organisation. The science on knowledge translation is still evolving with a multitude of theories, frameworks and models being postulated. Review and comparison of three translation research methodologies are described in this study. The rationale for selecting the Joanna Briggs Institute (JBI) model of evidence-based health care in a practical case study on the prevention of venous thromboembolism (VTE) in an acute tertiary referral teaching public hospital is provided. A planned and systematic approach to the implementation of best practice on this topic was undertaken utilising the JBI on-line resources and action research methodology. This required careful consultation and collaboration with senior clinicians by credible change agents, the provision of evidence and data relevant to individual specialties, the implementation of change strategies addressing individual, group and organisational barriers, and measuring the effectiveness and impact of changes over time. Lessons learnt from this process not only inform the study hospital on the effectiveness of the selected knowledge translation method but also contribute to the conversation within the scientific literature through the publication of three papers. The key publication describes the practical case study using the JBI implementation model and is accompanied by two further papers that provide examples of knowledge that have evolved from two of the action research cycles. These describe the use of computerised clinical decision support systems as an aid to knowledge translation and how a consumer focus group informed the production of a patient education video. This study is an important critique of the JBI model for evidence-based health care and its applicability for continued use in the study hospital as a feasible, appropriate, meaningful and effective model for evidence implementation. The JBI model is a conceptual framework that incorporates four integral and interdependent components: evidence generation; evidence synthesis; evidence/knowledge transfer; and evidence utilisation. The evidence utilisation component of the JBI model relates to the implementation of evidence into practice and reflects a planned action model. It provides a frame of reference for organised thinking and a structured and logical step-by-step progression through the planned action phases, underpinned and guided by the on-line resources. Improvements in compliance with three of the four evidence-based audit criteria were observed in the initial action cycle. The variable success was not attributed to a failure in the JBI model but was contributed to by contextual and logistical barriers mostly identified at the organisation level. The study hospital has a proven commitment to the implementation of evidence-based practice and translational research. Current and previous activities using the JBI model, coupled with the small, but growing, number of staff with training and/or experience in using the JBI tools, has seen a growing recognition and support for the model within the organisation. The JBI model is a feasible, appropriate, meaningful and effective method for evidence utilisation, subject to ongoing funds. The intended application of the study hospital to qualify as a JBI collaborating centre and ultimately to gain internationally recognised JBI endorsement, places the study hospital on a clear pathway to improving patient and health/systems outcomes and bridging the evidence-practice gap.