Evidence based health care is concerned with applying the best available knowledge, derived from research, clinical expertise and patient preferences, to achieve optimum processes and outcomes of care for patient. Research evidence, where it exists, provides an essential source of information feeding into the definition of standards and criteria, along with professional consensus and patient feedback. The processes of education, collaboration and involvement in quality improvement help to promote changes in the attitude and behaviour of staff, facilitating the uptake of new clinical practices, whilst audit provides a mechanism for monitoring the effect of these new practices on patient experiences and patient outcomes of care.
Developments in evidence based health care, therefore, are providing us with a framework which can be applied to link research more systematically into our familiar cycle of quality improvement. Research tells us what is best practice and quality improvement provides us with a method for implementing and evaluating that practice (as well as generating new questions for research).
This can be illustrated by the following two examples. The first example illustrates how research can inform quality improvement, leading to demonstrable improvements in patient outcomes. In relation to pressure area care, existing research highlights the beneficial effects of using 'at risk' assessment scales and pressure relieving devices (such as special mattresses) to reduce the risk of pressure damage to skin. In the UK, we have a number of national documents summarising the findings of relevant research, including a national clinical guideline on management of pressure areas. This has been used to inform standard setting and audit by clinically based quality
