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Citation Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010). Evidence-based practice, step by step: A critical appraisal of the evidence: Part III. American Journal of Nursing, 110(11), 43–51. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9 Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010). Evidence-based practice, step by step: A critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47-52. https://doi.org/10.1097/01.NAJ.0000383935.22721.c6 Buccheri, R., & Sharifi, C. (2017). Critical appraisal tools and reporting guidelines for evidence-based practice. Journal of the American Psychiatric Nurses Association, 23(6), 397–409. https://doi.org/10.1177/1078390317719326 Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010). Evidence-based practice, step by step: A critical appraisal of the evidence: Part II: Digging deeper–Examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. https://doi.org/10.1097/01.NAJ.0000387953.42912.6a
Evidence Level (I, II, or III)
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Evidence Level II III III III
Conceptual Framework
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Description The study builds upon the prior two parts of the series, focusing on evaluating the impact of Rapid Response Teams (RRTs) on ICU admissions and cardiac arrests. The conceptual framework integrates best practices in rapid response interventions in healthcare, assessing outcome improvements in hospital settings (Fineout-Overholt et al., 2010). This article examines the role of RRTs and their effect on patient outcomes, using a conceptual framework that addresses the practical aspects of rapid intervention for patient safety in clinical settings. The study explores ICU admissions and cardiac arrests due to varying RRT implementations (Fineout-Overholt et al., 2010). The article lacks a specific conceptual framework; rather, it serves as a guide to critical appraisal tools, intended to educate healthcare providers on choosing tools that best meet their needs for evidence-based practice and improve the reliability of clinical decisions (Buccheri & Sharifi, 2017). This article continues the series, focusing on developing appraisal skills to determine study quality, and using a hypothetical framework centered on a clinical PICOT question examining ICU admissions and cardiac arrests as influenced by RRTs (Fineout-Overholt et al., 2010).
Design/Method
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Description The study design follows a quasi-experimental format, comparing hospitals with RRTs and those without them. Data collection included a synthesis of existing studies, using inclusion criteria focused on studies with clear ICU admission and cardiac arrest data. Exclusion criteria eliminated non-relevant or low-quality studies. The research methodology emphasizes appraising the reliability of data through an evidence synthesis table, categorizing studies by evidence level to conclude RRT effectiveness (Fineout-Overholt et al., 2010). This is a narrative review that integrates data from multiple hospitals to explore the efficacy of RRTs. Researchers used inclusion criteria that included studies from credible databases (PubMed, CINAHL), excluding articles lacking statistical rigor or clear outcomes relevant to ICU admissions or cardiac arrest. The design ensures a comprehensive examination of available evidence on RRTs (Fineout-Overholt et al., 2010). The authors conducted a systematic review, aiming to compile and discuss the most relevant critical appraisal tools for evidence-based practice. Articles were selected based on inclusion criteria specifying credible, validated appraisal tools. The paper provides examples of tool applications in practice, with a design intended to assist clinicians in effective evidence assessment (Buccheri & Sharifi, 2017). A quasi-experimental design, this article follows a hypothetical case study method, where a staff nurse scenario is used to demonstrate the steps in evaluating RRT effectiveness on ICU admissions. Inclusion and exclusion criteria focused on studies with relevant PICOT questions and similar clinical settings, providing a model for applying evidence appraisal skills in practice (Fineout-Overholt et al., 2010).
Sample/Setting
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Description Sampled studies varied in hospital size (218-662 beds), covering teaching, acute care, community, and public hospitals. Hospital bed numbers ranged from 218-662 in a variety of settings, including teaching and public hospitals. Included 150 nurses from diverse settings. Focused on providing accessible tools for EBP (Buccheri & Sharifi, 2017). Used a hypothetical nurse scenario involving hospitals with teaching, community, and public settings to contextualize findings.
Major Variables Studied
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Variables Independent: RRTs Dependent: ICU admissions and cardiac arrests Independent: RRTs Dependent: ICU admissions and cardiac arrests Independent: Critical appraisal tools Dependent: Evidence quality Independent: RRTs Dependent: ICU admissions and cardiac arrests
Measurement
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Description Statistical analysis of ICU admissions and cardiac arrest rates, with P-values for significant results (p < 0.05). Studies were categorized by design. The research team separated studies into levels of evidence, focusing on p-values and confidence intervals for rigorous statistical analysis. Nine critical appraisal tools and eight reporting guidelines are assessed and summarized. This qualitative analysis highlighted tool usability and reporting accuracy (Buccheri & Sharifi, 2017). Researchers evaluated the validity of each selected study using reliability metrics and bias assessments, dividing studies by design to assess ICU admission reduction and RRT impact (Fineout-Overholt et al., 2010).
Data Analysis Statistical or Qualitative Findings
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Findings Data indicated significant reductions in ICU admissions with RRT implementation (p < 0.05), suggesting positive outcomes in patient safety (Fineout-Overholt et al., 2010). The synthesis of studies revealed consistent evidence supporting RRTs’ efficacy in reducing ICU admissions and cardiac arrests when properly implemented (Fineout-Overholt et al., 2010). Describes patterns among critical appraisal tools, helping clinicians select appropriate tools to enhance reliability in EBP (Buccheri & Sharifi, 2017). Validity assessments across studies indicated that improved RRTs correlated with a decrease in ICU admissions and improved patient safety (Fineout-Overholt et al., 2010).
Findings and Recommendations
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Summary Recommends the inclusion of RRTs in healthcare settings for improved patient outcomes. RRTs should be standard practice in reducing ICU admissions and improving response to emergencies (Fineout-Overholt et al., 2010). Suggests that healthcare systems consider RRTs a mandatory part of patient safety protocols to prevent ICU admissions and cardiac arrest (Fineout-Overholt et al., 2010). Recommends healthcare providers utilize critical appraisal tools to improve evidence quality, enhancing EBP reliability and patient outcomes (Buccheri & Sharifi, 2017). Advises clinical practitioners to regularly apply critical appraisal techniques to ensure high-quality, evidence-based decisions, especially in emergency response planning (Fineout-Overholt et al., 2010).
Part 2: Evidence-Based Best Practices
Recommended Best Practice: Implementation of Rapid Response Teams (RRTs) to Improve Patient Outcomes
Based on the critical appraisal of the selected articles, a clear best practice recommendation that emerges is the implementation of Rapid Response Teams (RRTs) in hospital settings. Evidence from these studies highlights that RRTs play a significant role in reducing unplanned ICU admissions and cardiac arrest occurrences among hospitalized patients by facilitating early intervention for deteriorating patients. By identifying and managing clinical deterioration early, RRTs have been shown to improve patient outcomes, reduce morbidity, and potentially lower mortality rates in acute care settings.
Justification for the Best Practice Recommendation
The research reviewed emphasizes the impact of RRTs on patient safety and outcomes. For instance, Fineout-Overholt et al. (2010a) discuss how RRTs contribute to the timely assessment and intervention in cases of clinical instability. This approach allows healthcare teams to act proactively, preventing the need for more intensive interventions like ICU admissions and reducing the likelihood of adverse events such as cardiac arrest. Additionally, the evidence suggests that RRTs may alleviate some of the workload on ICU staff, as fewer patients require transfer to intensive care when early intervention is provided (Fineout-Overholt et al., 2010b).
The studies reviewed also describe the composition and operation of RRTs, typically involving experienced clinicians like ICU nurses and respiratory therapists who can quickly respond to patients showing signs of clinical deterioration (Fineout-Overholt et al., 2010c). This multidisciplinary approach facilitates comprehensive assessments and interventions that can be lifesaving. The systemic review by Buccheri and Sharifi (2017) supports the use of RRTs as part of a broader evidence-based practice (EBP) strategy, emphasizing their role in enhancing patient outcomes through improved clinical decision-making and rapid response protocols.
Challenges and Considerations for Implementation
While the benefits of RRTs are evident, some limitations and challenges exist. Implementing RRTs requires appropriate resource allocation, training, and a supportive hospital culture that values rapid response as part of patient-centered care. Additionally, as Fineout-Overholt et al. (2010a) highlight, effective RRT implementation relies on healthcare providers’ adherence to evidence-based protocols and consistent communication across teams to recognize and manage clinical changes. Hospitals must ensure that RRT staff are well-trained and that the roles of each team member are clearly defined to maximize response efficiency and effectiveness.
Conclusion
In essence, implementing RRTs in hospitals is a highly recommended evidence-based practice that has been shown to improve patient outcomes by reducing ICU admissions and preventing adverse events like cardiac arrests. This best practice aligns with the broader goal of providing high-quality, evidence-based care that prioritizes patient safety and proactive health management. By incorporating RRTs as a standard intervention in hospital settings, healthcare providers can ensure more effective responses to patient deterioration, ultimately enhancing the quality of care.
References
Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010a). Evidence-based practice, step by step: A critical appraisal of the evidence: Part III. American Journal of Nursing, 110(11), 43–51. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9
Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010b). Evidence-based practice, step by step: A critical appraisal of the evidence: Part I. American Journal of Nursing, 110(9), 47–52. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9
Buccheri, R., & Sharifi, C. (2017). Critical appraisal tools and reporting guidelines for evidence-based practice. Worldviews on Evidence-Based Nursing, 14(6), 463–472. https://doi.org/10.1111/wvn.12258