What is E3BP?

E3BP: Dollaghan’s (2007) conceptual framework guiding the NSW Speech Pathology EBP Network:

Dollahgan’s (2007) conceptual framework of E3BP guides discussions during our meetings, and our thoughts about how findings from empirical research might be adopted into our various workplaces, in light of our own internal evidence and the patients/families we work with.

What is the difference between EBP and E3BP? Evidence-based practice (EBP) was defined by David Sackett and colleagues as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71).  While this definition has been instrumental in developing a global culture of EBP among health workers, it assumes that the application of research evidence is straight forward. In practice, it is not. The application of research to practice and the process of making clinical decisions in unique workplace settings with unique workplace constraints, with individual clients on a case-by-case basis can be complicated.  Clinical settings are different, and clinicians have different types of expertise and experience. Clinical settings also have different types of resources as well as policies and procedures regarding how they are to be used.

In an effort to bring some balance between empirical research evidence, what is possible in everyday clinical practice, and, individual client characteristics, values and preferences,  Chris Dollaghan proposed a modified definition of EBP, known as E3BP. Dollahgan (2007, p. 2) defines  E3BP as “the conscientious, explicit, and judicious integration of 1) best available external evidence from systematic research, 2) best available evidence internal to clinical practice, and 3) best available evidence concerning the preferences of a fully informed patient.”

This means that:

EXTERNAL EVIDENCE = the peer-reviewed published research literature or empirical evidence

INTERNAL CLINICAL EVIDENCE = evidence from clinical practice (i.e., practice-based evidence). It may include outcome measures for an individual patient and/or patient satisfaction ratings associated with a particular clinical decision for a patient/s.  Internal clinical evidence could comprise evidence from an individual speech pathologist working with a specific client group, and/or evidence from a workplace for all patients with a particular type of communication or swallowing difficulty, managed by a team of speech pathologists.

INTERNAL PATIENT EVIDENCE = the characteristics of clients, their values, beliefs, and preferences.

Clinical expertise integrates all three sources of evidence (published literature, clinical evidence, client evidence) in the provision of optimal clinical care (Dollaghan, 2007). Dollaghan (2007) considers clinical expertise to be “the glue by which the best available evidence of all three kinds is integrated in providing optimal clinical case (p. 3).

5 steps of E3BP 

There are five steps involved in the conduct of E3BP. They include:

  1. Formulating a clinical question. This could begin with a background question or topic area, then transformed into a specific clinical question, that adheres to the PICO elements – patient, intervention, comparison, and outcome.
  2. Searching for evidence: Helpful sites particularly relevant to speech pathology practice include:
    http://speechbite.com/
    http://www.asha.org/Evidence-Maps/
    http://www.thecochranelibrary.com/
    http://www.campbellcollaboration.org/library.php
    http://www.psycbite.com/
    http://www.tandfonline.com/toc/tebc20/current
  3. Critical appraisal of the evidence: Evidence includes external published evidence, and relevant internal evidence from your own clinical practice. There are helpful checklists to guide your critical of external evidence http://www.casp-uk.net/casp-tools-checklists
  4. Implementation: This involves the implementation of a clinical bottom line (or a modified version of a clinical bottom line after problem-solving barriers and enablers to clinical practice). It can also involve the adoption of strategies for facilitating the application of  evidence into practice, such as focused meetings about the change to practice, audit and feedback on clinical practice, the creation and use of printed materials about the change, e-reminders) (Grimshaw, Eccles, Lavis, Hill, & Squires, 2012). Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation Science, 7(1), 50. doi:10.1186/1748-5908-7-50
  5. Evaluation: It is important to evaluate the impact of a change to clinical practice and/or how the application of a modified form of a clinical bottom line has changed (or not changed) clinical practice. There are multiple ways to measure impact. The most common would be to collect data using a reliable and valid outcome measure

References

Dollaghan, C. A. (2007). The Handbook for Evidence-Based Practice in Communication Disorders. Baltimore: Paul H.  Brookes Publishing Co.

Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence-Based Medicine: What It Is And What It Isn’t: It’s About Integrating Individual Clinical Expertise And The Best External Evidence. BMJ: British Medical Journal, 312(7023), 71-72.  Retrieved from http://www.jstor.org.ezproxy1.library.usyd.edu.au/stable/29730277