Research, Evidence-based Practice, and QI: A Roadmap for Multidisciplinary Teams
Healthcare providers face a sobering reality: 400,000 unintended patient deaths occur annually, with adverse events affecting one in four hospital admissions. Yet these tragedies aren't due to incompetence—they can result from poorly-designed systems and inconsistent practices. Perhaps most striking, only 20-30% of healthcare decisions are based on solid evidence.
"Research, Evidence-based Practice, and QI, Oh My!" a session held at this year’s NBDF Bleeding Disorders Conference, offered nurses, social workers, and physical therapists a clear framework for changing these statistics. The session provided attendees with practical guidance on how multidisciplinary teams can systematically improve patient care through three complementary approaches.
The Foundation: Three Critical Questions
Kelly Tickle, DNP, PCNS-BC, PPCNP-BC, EBP-C, opened the session by framing the solution around three fundamental questions that form the pillars of better care design:
- What is the best thing to do? (Research - generates evidence)
- Are we doing the best thing? (Evidence-based practice - translates and implements evidence)
- Are we doing the best thing continuously? (Quality improvement - sustains best practices)
"As nurses and allied health professionals, research, evidence-based practice and quality improvement should provide a foundation for the clinical care we provide to ensure care is based on sound evidence that has been proven to improve patient safety and health," Tickle emphasized.
Rather than relying on tradition, trial and error, or previous knowledge alone, she advocated for transdisciplinary training based on evidence-based practice—a collaborative approach that combines multidisciplinary team skills for more unified, holistic care.
Research: From Clinical Questions to Scientific Evidence
The research process follows a systematic pathway: identify the problem, review current medical literature, formulate research questions or hypotheses, choose study design, plan sampling, collect and analyze data, then share results. While this may seem daunting, Tickle's advice was encouraging: "You don't have to use the whole staircase, just take the first step."
Amanda Stahl, LISW, from Boston Bleeding Disorders Center at Brigham & Women's Hospital, illustrated this perfectly. Her clinical observation of recurring trauma symptoms among adult hemophilia patients led to a five-year research project when she discovered this particular area of concern remained unstudied—despite extensive research on pain, adherence, quality of life, and depression.
Stahl's journey from clinical question to published research followed 13 detailed steps, from developing the research question through the inevitable "100,000 revisions" to final publication. Her key insights included the importance of:
- Identifying gaps in existing knowledge
- Organizing a collaborative team early, including statisticians before writing protocols
- Completing required CITI training and IRB approval
- Choosing appropriate methodology (qualitative vs. quantitative)
- Being generous with collaboration throughout the process
"I hope this session empowers social workers (and healthcare providers in all disciplines) to see research as something they can be part of without feeling intimidated," Stahl said. "The work we do every day already makes a significant impact, and by formalizing it into research, we can extend that impact beyond our patients to benefit the wider bleeding disorders community."
Evidence-Based Practice: Translating Knowledge into Action
Evidence-based practice (EBP) follows a slightly different path than pure research, focusing primarily on implementation and methodology questions like "What can we do differently so our patients can receive better care?" and "Why does another unit have different practices than our unit?"
Tickle recommended using the PICO method to frame these questions:
- Population/Patient/Problem
- Intervention
- Comparison
- Outcome
Tickle shared an example of how to apply PICO to a question for bleeding disorders: "In females with a bleeding disorder (P), what treatment options for heavy menstrual bleeding (I) compared to our current practice of antifibrinolytic therapy alone (C) impact pictorial bleeding assessment scores (O)?"
The evidence-based practice process involves asking focused questions, searching the medical literature, appraising existing evidence, selecting the best evidence, linking it with clinical experience and patient values, developing action plans, and ultimately, implementing one’s findings, evaluating the results, and disseminating final outcomes.
Quality Improvement: Sustaining Excellence
Anne Gonzales, PT, DPT, from Nationwide Children's Hospital, addressed quality improvement as "a journey to achieving best patient outcomes"—not a short-term fix, but an ongoing, team-based commitment.
Her QI framework includes: defining problem needs through data, forming teams and developing aims, mapping processes, conducting cause analysis and identifying key drivers – prior to
The aim serves as the QI goal—a specific, measurable statement that answers the question, "What are we trying to accomplish?" Key drivers represent significant causes or essential needs influencing this aim, while interventions are specific tests of change likely to improve one or more key drivers.
Gonzales emphasized that QI provides a framework to systematically improve patient care by implementing known best practices, standardizing processes, and measuring outcomes over time. Her encouraging message to the audience was, "You may not realize it, but you do Quality Improvement every day!"
Getting Started: NBDF Support and Resources
Recognizing that research can seem intimidating, Maria Santaella, RN-BC, MSN, PhD(c), NBDF's vice president of research, outlined extensive support available to clinicians. NBDF offers funding through Nursing, Social Work, and Physical Therapist Excellence Fellowships, along with statistical support, application submission assistance, and access to Community Voices in Research.
Moving Forward
The session's core message was clear: improving patient outcomes requires systematic approaches, but the journey begins with collaboration and curiosity. Whether through research that generates new evidence, evidence-based practice that implements proven strategies, or quality improvement that sustains best practices, multidisciplinary teams have the tools to transform healthcare delivery.
As Tickle concluded, "It all starts with a question. Collaborate with your team and the other resources in your practice." For bleeding disorders patients and healthcare providers alike, that first step toward evidence-based excellence is within reach.
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