USE OF EVIDENCE IN THE PROCESS OF PRACTICE CHANGE IN A CLINICAL TEAM - A STUDY-FORMING PART OF THE AUTOCONTROL PROJECT

The Autocontrol Project is concerned with the accessing, processing an d communication of high quality information so that a clinical team ca n make and implement decisions for practice change, and then evaluate if improvement has been achieved. High quality information is used as evidence for change. In this study, we have evaluated how evidence is used by a clinical team to explain an identified problem of inappropri ate use of blood gas tests. In an experimental study of the Surgical I ntensive Care Unit, video recordings of team meetings of nurses and do ctors were undertaken, structured according to a problem-based format. Evidence of current practice patterns derived from the hospital infor mation system, as well as the results of a questionnaire to the unit's staff about knowledge and use of blood gas measurements, were supplie d to the participants beforehand. At the second meeting, the output of the first meetings and a summarised analysis of pertinent literature were made available. This second meeting was required to finalise the list of causes of inappropriate blood gas use and propose pragmatic st rategies for practice change. The video data of the meetings were code d to analyse the use of evidence, the categories of causes, issues and solutions proposed, and the quality of team interaction. The results indicate that in order to achieve consensus, the team used different t ypes of evidence, including objective evidence of practice patterns, p ersonal experience about direct and indirect organisational influences , and literature-based research evidence of best practice. Furthermore , group dynamics were favoured by the problem-based meeting structure, and a high level of cognitive critiquing between team members was obs erved. This research suggests that a combination of approaches involvi ng identification of both operational factors (e.g. appropriate access to different types of evidence and meeting structure) and cognitive a nd behavioural approaches (e.g. ensuring expression of different viewp oints) is needed to support strategic decision-making for practice cha nge in a clinical unit. This combined approach should favourably influ ence the provision of an effective and efficient evidence support envi ronment for the clinical team. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.