Introduction
According to the AHRQ model, Evidence-Based Practice (EBP) involves three stages: Knowledge creation and distillation, diffusion and dissemination of the information and adoption, implementation and institutionalization (Nieva et al., 2005). These three basic phases can then be used to construct an EBP based healthcare delivery plan that guides Registered Nurses (RNs) and Health Care Practitioners to implement the newest and most efficient treatment practices (Titler, 2008). How would such an plan look in practical terms for Coronary Bypass Surgery in a heart failure clinic? During Coronary Artery Bypass Graft Surgery (CABG), peripheral blood vessels from the limbs are used to bypass a blocked coronary artery. Briefly, the surgeon cuts through the sternum to expose the heart, insert tubes so the blood can be pumped through the body by a heart-lung bypass machine. The surgeon then cuts a piece of an artery from an arm or leg and attaches/inserts it to the heart so that the blood can freely flow through the new artery instead of the blocked one.

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Knowledge creation and distillation
The first step in implementing the health care plan is actually the access of new knowledge about the corresponding technique, in this case CABG surgery. Here, the focus will be on the nursing side rather than the surgery side of the procedure – since the plan should be universally valid no matter the exact variation of the surgery method.
The most common way to acquiring new information is either through direct communication with in-house nursing staff and building on the accumulated personal information, or by scouring the literature databases, for example pubmed.com. A combination of both might be best since it shows what type of information is specifically needed, such that the database searches can be done in a more efficient manner.

One example could be the treatment of patients that suffer from Stable Ischemic Heart Disease (SIHD). These patients have permanently blocked coronary artery, such that the heart muscle does not get enough oxygen; CABG surgery is one way of treating the disease. A search on pubmed.com yields a review by Patel and Bangalore (2017).

The next step is the extraction and distillation of knowledge from that article and potentially others. For example, the authors recommend weighing the risks and benefits for each patient individually when deciding whether to get CABG surgery or a simple drug-based technique, and suggests guidelines how to treat patients based on their symptoms. These are important factors to know for every nurse.

Diffusion and Dissemination
The next step is the Dissemination of the acquired information, in other words: the efficient information of the healthcare providers and hospital staff about the study results. There are different possibility to communicate the knowledge: department seminars with PowerPoint presentations; formation of smaller teams that directly communicate with each other and bundle their knowledge to persuade the associated healthcare practitioners and surgeons. If the modes of communication are chosen wisely, the brainstorming sessions will generate new questions and ideas, which can then be further researched by going back to the knowledge creation and distillation step, until in the end the problem has been specifically fleshed out that a very targeted and efficient treatment can be administered.

In the example of CABG surgery, the information from scientific studies can be cross-checked with actual experience in the clinic to determine which patients need surgery and which patients usually recover on their own with prescribing the best mix of drugs and lifestyle changes. That way, not every patient has to undergo surgery, freeing resources for those that actually need CABG interventions.

Organizational Adaptation and implementation
In the third step, the disseminated information can be used to develop interventions and ways to adopt and implement the procedures. Some patients need treatment directly in the department, others can be sent home for periodic treatments, and a third group of patients may actually be helped by changing the lifestyle without further surgery.

Of course, as mentioned above, the disseminated information from research studies can be applied to various real world situations, which then leads to new questions and a further refinement of treatment methods, until current research methods are optimally aligned with hospital practices.

    References
  • Nieva V, Murphy R, Ridley N, et al. (2005) Advances in patient safety: from research to implementation. Rockville, MD: Agency for Healthcare Research and Quality; 2005. From science to service: a framework for the transfer of patient safety research into practice.
  • Titler M. (2008) Chapter 7. The Evidence for Evidence-Based Practice Implementation. From Hughes, R.G. (ed.) Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD. Agency for Healthcare Research and Quality (US).
  • Patel AV, Bangalore S. (2017). Challenges with Evidence-Based Management of Stable Ischemic Heart Disease. Current Cardiology Reports 19(2):11.