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processing, and implementing research findings into the work field with the goal being to
improve the clinical practice, patient outcome, or the work environment. The use of evidence-
based practice allows healthcare professionals to provide the most competent and cost-efficient
patient care using the latest research. Nurses, physicians, and other healthcare professionals
utilize evidence-based practice in their daily duties to answer clinical questions when treating
their patients. For example, in the emergency room practice, how does treating patients based on
acuity differ from treating patients on a first come first serve basis? An evidenced-based
approach facilitates the answers to this and many more clinical questions promptly to prove that
implementing evidence-based research into practice improves patient care and outcomes
(Melnyk et al., 2010). A direct track to achieve and improve patient care delivery and outcomes
is by utilizing evidence-based practice which is highly accepted as the key to the success of
quality and safe healthcare delivery from healthcare professionals (Chien, 2019).
The quadruple aim is the addition of a fourth aim to the already existing triple aim. The
Triple aim is a framework guiding healthcare delivery in the United States developed by the
Institute for Healthcare Improvement (Longbrake, 2017). The triple aim framework composes of
reducing costs, improving population health, and improving patient care experience. The
additional domain to create the quadruple aim is the well-being of the healthcare team (Arnetz et
al., 2020). The additional fourth aim focuses on the importance of improving healthcare worker
satisfaction in the workplace, for many healthcare organizations, adding the fourth aim to create
the quadruple aim allows joy in the workplace and health equity (Feely, 2017). Wong et al.,
impossible without healthcare workers that are physically and physiologically healthy. Evidence-
based practice can be applied to the quadruple aim through the suggestions of shared decision
making and addressing each component of the quadruple aim to maintain and promote an
Patient Experience
To aid healthcare providers in clinical decision-making and health management, the use
of patient-reported outcome measures can be utilized to achieve the health outcome that is
expected by most patients ( Iglesia et al., 2020). Melnyk et al., (2014) state that a problem-
the best evidence from studies that are well designed and integrates it with a patient’s preference,
values, and a clinician’s expertise (internal evidence from patient data). Evidence-based practice
can contribute to the development of the Quadruple aim through the patient experience once
healthcare professionals use well-ordered research skills and apply the evidence of scientific
knowledge to their clinical practice based on the needs of the patient. Evidence-based practice is
a vital part of providing safe and quality healthcare to patients, and healthcare professionals must
be up to date with current practices to provide competent care to those with complicated
conditions.
strategies have had a positive influence on patient perceptions of the care they received while in
the emergency department and increased satisfaction ratings including bedside shit report, hourly
rounding, and most importantly AIDET ( acknowledge, introduce, duration, explanation and
is of important value to patients and their families. The patient experience commonly correlates
to the process of care for disease prevention and management and also the communication with
their health providers. A satisfied patient experience also integrates the patient’s adherence to the
medical advice and treatment plans. For example, a study reported in an article by Agency for
Healthcare Research and Quality (n.d), showed that patients who were hospitalized for heart
attack and reported positive patient experiences with care had better health outcomes after one
year of discharge.
Population Health
science-based interventions with community preferences for improving the health of the
health could result in direct and indirect benefits to the healthcare system; this could include
better or more access to quality information on best practices, yield success in disease prevention
programs, and increase workforce productivity (Lhachimi, 2016). According to Melnyk et al.,
(2010), without using modern or present-day evidence-based approaches, healthcare practices are
quickly outdated and sometimes can often be detrimental to patients. The authors gave an
example, taken from the task force on sudden infant death syndrome (SIDS) in 2016, relating to
pediatric care; for years healthcare providers encouraged parents to place infants in the prone
position while sleeping as this was the best position to prevent aspiration. However, research
conducted indicated that the prone position increases the risk of sudden infant death syndrome,
now the recommended position for infant sleep is a supine position which has resulted in a
practice that will have a positive effect on population health are nurses. According to Dawes et
al., (2005) and Hockenberry et al., (2008), as cited in Crabtree et al., (2016), best practice occurs
when healthcare professionals continually question treatment and care, uses resources and
necessary skills to search and evaluate evidence, and then implementing that evidence into
practice to determine the effectiveness on population health. Therefore, once health practitioners
utilize evidence-based practice, they can meet the demands for a systemic approach to solving
problems associated with population health yielding measurable outcomes (Jacobs et al., 2012).
Costs
One of the most challenging factors for healthcare facilities and patients seeking
healthcare is costs, it is also an important outcome for the quadruple aim. High medical costs
have been a significant impediment in patients seeking and receiving medical treatment, and this
may even cause some to suffer or even succumb to their illness due to this issue. According to
Longbrake (2017), the aim of the triple aim as it relates to costs is to cause a reduction in
healthcare costs; and this is adapted in the quadruple aim. As health systems adapted globally,
they struggled with the challenge of improving healthcare while lowering healthcare costs (Sikka
et al., 2015). However, does the reduction in healthcare costs benefit the patient or the healthcare
facilities? This is where evidence-based practice comes into play. Melnyk et al., (2010) report
improving health outcomes, enhancing the quality and rehabilitation of health care, and most
Applying evidence-based practice yields better patient outcomes which in turn will
decrease the demand for healthcare resources and further reduce the expenses on healthcare
equipment or products that are no longer necessary for certain procedures or techniques; but this
may cause longer hospital stay for the patient and increase the costs for healthcare by the patient.
Facilities should in co-operate evidence-based practice by utilizing the most modern technology
and practices, it will automatically increase the cost of healthcare for the facility, but the benefits
of the cost, in the long run, will outweigh the use of outdated technology for both the patient and
healthcare facility. Adilyet al., (2004), argues that the application of evidence-based healthcare
practice has the potential to be the most effective and efficient way to cope with the inevitable
collaboration of health professionals. Acknowledging the concerns and importance of our nurses,
doctors and other healthcare professionals contributing to the health system is vital, as this
provides a sense of confidence and empowerment in their practice. According to Fridman &
Frederickson, 2014; Kim et al., 2016, 2017 as cited in Melnyk et al., 2010 results from studies
have indicated that healthcare professionals feel empowered with a higher job satisfaction when
they engage in evidence-based practice. With the addition of a fourth aim, the quadruple aim
addresses the importance of improving the experience of those who provide care (Sikka et al.,
2015). Burnout and depression among health care professionals from pressure to deliver quality
and safe care under heavy patients loads have increased over the years. However, Melnyk et al.,
(2010) report that the use and teaching of evidence-based practice may be the key to not only
providing competent care but also reducing the high turnover rate of healthcare professionals due
concerns, this can be done through simple surveys; and previous surveys can be used in
evidence-based practice to improve the work-life of healthcare professionals (Sikka et al., 2015).
In a previous US survey conducted in 2013, 51 percent of nurses expressed that their job affected
their health, while another 35 percent reported feeling to resign from their current job due to
dissatisfaction. These results can be included in evidence-based practice to find solutions to these
issues healthcare professionals face (Sikka et al., 2015). Evidence-based practice also has
one such example is charting. Take for example the use of technology in today’s workspace
through the use of the electronic medical record (EMR) that replaced the time-consuming and
Evidence-based practice is an approach to clinical practice that has been gaining attention
since it was introduced in 1992 (Chrisman et al., 2014). Healthcare professionals have been
exposed to evidence-based research and practice since the beginning of their professional
journey and it has vastly contributed to the quadruple aim. The additional aim to the triple aim to
develop the quadruple aim has fostered quality patient outcomes while empowering the medical
clinicians. The implementation of evidence-based practice in health care has benefited the
overall patient experience, health of the population, costs, and the well-being of healthcare
professionals.
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