The Importance of Evidence-based Practice in Imaging

There is an increasingly strong belief that NHS services should be of high quality and that they should adhere to evidence-based research as the best practice. There is a large body of information supporting the benefits of evidence-based practice in health care application and planning. To this end, there are many policy documents that have emerged to guide medical researchers. It is therefore necessary, that employees working within NHS imaging services are aware of how to undertake evidence-based practice and what resources are available to them to ensure their practice is based on the best available up-to-date evidence.

Evidence- based practice (EBP) in medicine advocates for the use of the best current evidence while attending to the individual patients. It means the integration of individual clinical proficiency and knowledge from the best external clinical evidence that is available from a systematic research. The individual clinical expertise relates to the proficiency and the decision making skills that individual medical practitioners acquire through their experience and practice (Stout & Hayes, 2005). Development of clinical expertise is reflected through the effective and efficient diagnosis and through the personal judgment in utilizing patients’ rights and preference when making clinical decisions concerning their care. Using the best available external clinical evidence refers to the clinically appropriate research on specific medical aspects as indicated in the basic sciences of medicine. However, the external clinical research has to be patient-centered more so in the accuracy of diagnostic tests and the safety of the procedure used.

The earlier definition indicated above was later developed after it was realized to contain some limitations in practice. Some group of physicians from Canada noted that the definition did not focus on traditional determinants of clinical decisions but instead emphasized on clinical research. Therefore, this led to the contemporary definition of EBP as an integration of the best research evidence with clinical expertise and patient values. The current definition focuses on the patient’s condition, the patient’s goals and values, the best available research evidence and the clinical expertise of the medical practitioner (Sackett et al., 1997). What this tries to highlight is that a patient may not accept the interventions with strong research as suggested by a clinical expert due to differences in beliefs and values. Likewise, the clinician may not be in a position to access the best researched evidence due to financial limitations or lack of relevant resources. In such a situation, the use of the best research evidence may be impractical to offer. There are also some instances where the clinician may also realize that the best research was conducted under different circumstances. The differences that may be noted in research include the use of a different population that does not reflect the needs of the current patient, or other factors such as age, medical conditions, culture, and gender.

Many social workers have endorsed the contemporary definition of EBP and have also applied it in their various publications. They usually emphasize the client values and opinions as being an important part of intervention planning. In addition, social workers argue that patients should be fully involved in the intervention planning instead of being given a summary of what is appropriate to the medical experts (Drisko & Grady, 2012). By actively involving clients in the intervention planning, they get motivated and empowered and hence the process produces more acceptable results.

Evidence-based practice is an effective approach that improves the effect of practice in medicine, social work, nursing, psychology, and other related fields. Obviously, medical practitioners have used evidence during their practice for many years. In particular, they have used and credited different kinds of evidence related to their medical fields. EBP puts emphasis on the need to rely on large-scale research comparisons to find out the efficiency of various treatments against untreated control groups (Cilika, 2005). This is done because a research that is well done can indicate whether the treatment used caused any change. It is also important to note that EBP may include non-experimental research since it may be unethical or impractical to administer experiments to some populations.

The external evidence gathered by medical practitioners during EBP, does not make decisions for the experts but assists them to determine the best action to take based on the prevailing situations of their patients (Roberts & Yeager, 2004). The integration of all the elements of EBP improves the clinical outcomes and the quality of life for the patients. However, this can only be achieved if clinicians use their skills to search for efficient experiments that have used appropriate and reliable methodology.

Radiographers use evidence in their daily practice but most of them have not yet embraced the use of evidence-based practice (EBP). For many years, radiography has not been perceived by many medical practitioners as a discipline that requires investigation (Kurmis, 2003). This has contributed to the continued use of traditional skills by the radiographers, which has also been spreading to other health professions.

Currently, there is increased pressure for radiographers in various parts of the world including UK and Norway to be efficient and effective in their medical practice. As a result, radiographers are required to acquire the latest evidence in their field in order to provide high quality services to the patients (Decker & Iphofen, 2005). Normally, it takes around two years to translate research findings into actual practice. This is what has led to the increased use of EBP in radiography. For one to become a practitioner with necessary skills in evidence-based radiography there is need to be competent in searching medical articles from the internet. In addition, it requires individual commitment and a sense of purpose for the evidence-based radiography. Through this practice, radiographers are able to demonstrate their skills in decision making.

The environment where radiographers operate from is changing in NHS and in other health systems. This is particularly notable with the continued combination of medical images and communication systems, and the computer-based integrated health care enterprise (IHE). In the future these changes can be used to promote the radiographers’ interaction with the best available information and the preferences and values aimed at improving the quality of service offered to clients. It is understandable that medical practice is becoming busier for medical practitioners to spend so much time reading and reflecting on past studies in search of relevant information (Brealey, 2001). In this regard, there is need to have the skills to enable physicians peruse literature more effectively and to understand the operations of modern communication systems. EBP provides basic methods, tools, and principles that can help radiographers overcome this challenge. As a result, this improves their management skills and service delivery to their clients.

Evidence-based practice differs from the ordinary practice in two crucial ways. First, the fundamental of EBP is its explicitness where relevant literature is categorized according to type such as diagnosis, reviews, and therapy. In an objective critical assessment, standard questions are applied to establish the validity of the evidence (Dobson & Craig, 1998). Then, the strength of the results is assessed through standard calculations. It is this explicitness that makes the results of EBP transparent and reproductive. Second, the objective of EBP is to offer medical practitioners with tools and regulations that would enable them to undertake their own evaluations as part of their individual practice (Gibbs, 2003). As a result, practitioners formulate solutions for individual patients and departmental challenges, using the best current evidence found in research. This may however be different from the principles that have been followed in the development of standard guidelines in radiography. In most cases, such guidelines depend on the views of experts that are often outdated and not applicable to individual practice.

In evidence-based radiography (EBR), the radiographer should be conversant with all the necessary steps in EBP. In the first step, the radiographer should identify the need for information (Stuart & Lilienfeld, 2007). The second step involves formulating a question. Here the radiographer should get data from the client and then developing a hypothesis to explain the data (Smith & Taylor, 2007). The question should not be ambiguous and hence should relate to diagnosis or treatment. It should also highlight the benefits of interventions and the quality of care.

The third step of the EBP involves finding the current best evidence that can be applied to a given condition. This process may either be quite quick, depending on the search method or it can be time-consuming and frustrating for a radiographer. For the radiographer to be effective in searching for evidence, there are two types of electronic databases that are available (Kurmis, 2003). The first is the bibliographic that allows the user to search for information using citations from literature. This can be done using MEDLINE database. The second type is more refined and as it uses quality-filtered publications, but there is still very limited information on radiography.

Developing solutions for individual patients is done at the fourth step of EBR where the overall research-based evidence is critically assed to determine whether it is valid. This assists the radiographer to make decisions where their literature can be relied in providing the patient with the best services (Black, 1998). This calls for the radiographer to have evaluation and appraisal skills if the information is to be of any value to the patient. In the final step, the radiographer develops solutions for individual patients by integrating the evaluated results with the patient’s values and preferences and reflects whether the evidence was helpful (Howard, McMillen, & Pollio, 2003). It is critical to note that the external evidence should not replace the individual skills from the radiographer. Instead, the radiographer should use his skills and expertise to determine where the external evidence is useful to the patient.

Some of the advantages of the advantages of the evidence-based practice in radiography and imaging departments include giving patients access to the latest care methods. In return, this improves patient satisfaction and quality of service (Mantzoukas, 2008). The latest information in medicine is mostly an improvement of the previous information and hence tends to produce better results. By using EBR, radiographers are able to compare the previous studies conducted in the field of radiography and compare the results of such studies with the current condition of their patients (Jackson, 2007). Therefore, this eliminates chances of trying methods that may lead to failure or making the patient’s health condition worse. In addition, EBR also enables the management of the radiography and imaging departments to have confidence with their staff due to the high chances of producing quality outcomes while treating patients. When the imaging process is successful, the credit is not only given to the concerned radiographer, but also to the management of that that department.

However, there are also some disadvantages that are associated with EBR. In some cases, the radiographer spends a lot of time searching for the best available evidence research but at the end fails to get any relevant evidence. This amounts to a waste of time when the client may still be suffering. Again, the radiographer may search for evidence and only get evidence where the patients of the subjects used in the research were of different age or gender with the current patient. Such results may therefore not be helpful to the patient. In most instances, the process of getting research evidence is tedious and time consuming (Jackson, 2007). Even after getting the necessary research evidence, the radiographer must evaluate and appraise its applicability and hence consuming more time with one patient. With the continuing changes in some diseases such as cancer, radiographers may be attending to new types of cancer developments that have never been addressed before (Simpson, Segall, & Williams, 2007). The implication for this is that no evidence research will be available and hence prompting the radiographers to use any acquired skills.

Additionally, most health facilities advocate for the use of evidence-based practices by all their practitioners. Although these practices work, most of the times they limit the practitioners from coming up with new solutions especially for the unique patients (Gambrill, 2003). When all the patients are treated using same interventions, the physician’s personal input becomes limited. Most of the health facilities encourage the use of EBP in order to protect the overall business, especially in matters of insurance cover (Nightingale & Hogg, 2003). As a result, radiographers are unwilling to take risks of applying new techniques due to the fear of losing their medical license or being sued. This prevents the radiographers from expanding their creativity through the practical application of their skills and expertise, so that other future radiographers can also be relying on their evidence.

Although there have been notable development in the medical technology, radiographers have not made use of all the information they need in order to deliver a high quality and cost effective care to their patients. What is challenging for this is for the clinicians to keep updated with the changes in medical knowledge and how to learn and interpret it accordingly. For the radiographers, limited skills of scientific literature can be a problem In addition, there may be minimum training on how to combine research evidence with other types of information such as the client’s values and preferences, in order to formulate valid information (Melnyk, & Fineout- Overholt, 2005). Some other constraints include the limited use of electronic databases and outdated textbooks and journals.

Health care services practitioners and consumers are in need of high quality outcomes brought about by the evidence-based practice. The inclusion of EBP techniques in radiography and imaging is a promising move that will contribute to the further evolution of radiography in terms of training and practice. Evidence based radiography will uphold the use of research-based evidence both in NHS and in other health care facilities and will develop radiography as a discipline. EBR solves clinical problems by identifying the best available research that is evaluated by the radiographer for its applicability to the client. Through EBR, radiographers are empowered to assist individual patients by finding evidence-based solutions that address their values. This information can also be used by radiographers to formulate local departmental policies that can also be used by other radiographers in future. In general, EBR improves the quality of service delivery by providing patients with the most effective solutions for their problems. It also benefits the management of the radiography and imaging departments by offering solutions for client’s problems and hence boosting the confidence towards their employees and improves their organisation’s reputation. Although EBR may be time consuming and frustrating to the nurses, it is still one of the best approaches in providing the best imaging services will lead to patient satisfaction. In this regard, NSH and other health care facilities should strive to promote the use of EBR in their radiography and imaging departments for quality improvement in patient care. Certainly, practical radiography research needs to be developed by NHS with more people being encouraged to study EBR as this will contribute towards professional development of radiography.

List of References

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