Health care you want, but likely not getting.

• Position: YOUR LIFE

As hospital leaders continue to feel pressure to improve patient outcomes and reduce costs, a study at Ohio State University, Columbus, reveals one reason why many organizations fall short: use of evidence-based practice among chief nurses and their hospitals is relatively low, according to a survey led by Bernadette Melnyk, dean of the College of Nursing, who also serves as associate vice president for health promotion and chief wellness officer.

Many of the hospitals in the study reported poor scores on key performance measures, such as falls and pressure ulcers. 'We found that a substantial percentage of hospitals were not meeting national benchmarks for quality and safety," points out Melnyk. "As you look at explanations for why 30% to 40% of these hospitals aren't meeting benchmarks on these quality indicators, one key explanation is the low level of evidence-based practice occurring in those hospitals."

Multiple studies have shown that evidence-based practice results in high-quality care, improved population health, better patient experiences, and lower costs. While most chief nurses who participated in the survey said they believe in the value of evidence-based practice, more than half reported that it is practiced in their organization "not at all" or only "somewhat."

When asked to list their organization's top three priorities, they ranked quality and safety first and second. Evidence-based practice was ranked low.

Evidence-based practice brings together research, a clinician's expertise, and patient preferences and values to drive the best care and outcomes.

The Institute of Medicine has set a goal that 90% of health-care decisions be evidence based by 2020.

However, the approach is not the norm. For instance, children with asthma continue to be treated with nebulizers in many emergency rooms even though numerous studies have shown better outcomes and fewer hospitalizations when children are given a bronchodilator with a metered-dose inhaler and spacer.

"When patients get evidence-based care, they have 28% better outcomes. That's a big deal," notes study coauthor Lynn Ford, director of the Center for Transdisciplinary Evidence-Based Practice. 'There's a public perception that this is what hospitals are already doing, and the sad news is, many are not."

The study...