Received: 14 September 2022 | Accepted: 14 November 2022
DOI: 10.1111/wvn.12621
REVIEW ARTICLE
Evidence-based practice improves patient outcomes and
healthcare system return on investment: Findings from a
scoping review
Linda Connor PhD, RN, CPN, EBP-C1 | Jennifer Dean DNP, RN, APRN, EBP-C,
AGACNP-BC | Molly McNett PhD, RN, CNRN, FNCS, FAAN1 | Donna M. Tydings DNP,
1
RN, CNS-BC2 | Amanda Shrout DNP, RN, CCNS, CEN3 | Penelope F. Gorsuch DNP, RN,
NEA-BC, FACHE4,5 | Ashley Hole MSN, RN, FNP-BC, CPON6 | Laura Moore DNP, RN,
APRN, FNP-C7 | Roy Brown MLIS, AHIP8 | Bernadette Mazurek Melnyk PhD, APRN-CNP,
EBP-C, FAANP, FNAP, FAAN1 | Lynn Gallagher-Ford PhD, RN, EBP-C, NE-BC, DPFNAP,
FAAN1
1
Helene Fuld Health Trust National
Institute for Evidence-Based Practice in Abstract
Nursing & Healthcare, College of Nursing,
Background: Evidence-based practice and decision-making have been consistently
The Ohio State University, Columbus,
Ohio, USA linked to improved quality of care, patient safety, and many positive clinical outcomes
2
St. John Fisher University, Wegmans in isolated reports throughout the literature. However, a comprehensive summary
School of Nursing, Rochester, New York,
USA
and review of the extent and type of evidence-based practices (EBPs) and their as-
3
Sinai Hospital, Baltimore, Maryland, USA sociated outcomes across clinical settings are lacking.
4
Summa Health System, Akron, Ohio, USA Aims: The purpose of this scoping review was to provide a thorough summary of
5
The Ohio State University, College of published literature on the implementation of EBPs on patient outcomes in healthcare
Nursing, Columbus, Ohio, USA
6 settings.
Memorial Sloan-Kettering Cancer Center,
New York, New York, USA Methods: A comprehensive librarian-assisted search was done with three databases,
7
Family CareX, Denver, Colorado, USA and two reviewers independently performed title/abstract and full-text reviews
8
Affiliate Faculty, VCU Libraries, Health within a systematic review software system. Extraction was performed by the eight
Sciences Library, Virginia Commonwealth
University School of Nursing, Richmond, review team members.
Virginia, USA Results: Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria.
Correspondence Most articles (63.3%) were published in the United States, and 90% took place in the
Linda Connor, Helene Fuld Health Trust acute care setting. There was substantial heterogeneity in project definitions, designs,
National Institute for Evidence-Based
Practice in Nursing & Healthcare, The and outcomes. Various EBPs were implemented, with just over a third including some
Ohio State University, College of Nursing, aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19%
Columbus, OH, USA.
Email: measured return on investment (ROI); 94% showed a positive ROI, and none showed
a negative ROI. The two most reported outcomes were length of stay (15%), followed
[Correction added on August 28,
2023, after first online publication: by mortality (12%).
The Supplemental References file has
now been provided in the Supporting
Information.]
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in
any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. Worldviews on Evidence-based Nursing published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.
6 |
wileyonlinelibrary.com/journal/wvn Worldv Evid-Based Nu. 2023;20:6–15.
, EVIDENCE-BASED PRACTICE IMPROVES PATIENT OUTCOMES AND HEALTHCARE SYSTEM
|
17416787, 2023, 1, Downloaded from https://sigmapubs.onlinelibrary.wiley.com/doi/10.1111/wvn.12621 by EBMG ACCESS - KENYA, Wiley Online Library on [16/04/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
RETURN ON INVESTMENT: FINDINGS FROM A SCOPING REVIEW 7
Linking Evidence to Action: Findings indicate that EBPs improve patient outcomes
and ROI for healthcare systems. Coordinated and consistent use of established no-
menclature and methods to evaluate EBP and patient outcomes are needed to effec-
tively increase the growth and impact of EBP across care settings. Leaders, clinicians,
publishers, and educators all have a professional responsibility related to improving
the current state of EBP. Several key actions are needed to mitigate confusion around
EBP and to help clinicians understand the differences between quality improvement,
implementation science, EBP, and research.
KEYWORDS
evidence-based decision making, evidence-based practice, healthcare, patient outcomes,
patient safety, return on investment
I NTRO D U C TI O N in congruence with the checklist for Preferred Reporting Items
for Systematic reviews and Meta-Analyses extension for Scoping
Background Reviews (PRISMA-ScR; McGowan et al., 2020; Tricco et al., 2018).
The Covidence systematic review software was used for all stages
It has been three decades since evidence-based practices (EBPs) of the review, including title and abstract screening, full-text review,
were first introduced in the healthcare literature (Evidence-Based and data extraction.
Medicine Working Group, 1992). EBP is the recognized and desired The primary research question was, “When patients receive
standard for international transdisciplinary healthcare providers and care based on evidence, what are the outcomes?” The secondary
is supported by national, international, and professional healthcare research question was, “What type, frequency, and characteristics
organizations and regulatory agencies, such as the American Nurses of EBPs were published in peer-reviewed journals?”
Credentialing Center (ANCC, 2022), the American Nurses Association
(ANA, 2022), the Centers for Disease Control and Prevention
(CDC, 2021), the National Academy of Medicine (NAM, 2022). The Electronic search
goals of evidence-based decision-making (EBDM) are to reduce
variations in practice, enhance the quality of care, improve patient A medical librarian conducted a systematic search for published
outcomes, and reduce costs (Melnyk & Fineout-Overholt, 2019). English-language literature and searched the reference lists for
Numerous articles have been published on EBP, and many EBP guide- additional publications to identify published papers addressing
lines are available to guide much of the care clinicians provide. The EBP and patient outcomes. The databases searched were OVID
underlying assumptions of EBP are that EBPs result in better patient MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied
outcomes and are associated with reducing errors, risks, and costs. Health Literature (CINAHL). These databases were searched from
However, to our knowledge, there has been no comprehensive re- 1992 through July 5, 2020. We chose 1992 because this is when
view of the breadth and depth of EBPs implemented and their impact evidence-based medicine (EBM) was first introduced in the litera-
on outcomes across settings and populations. Therefore, this scoping ture. The search used a combination of keywords and controlled
review aimed to determine the frequency, type, characteristics, and vocabulary for the concepts addressing “evidence-based practice,”
outcomes of EBPs implemented in healthcare settings. “outcomes,” and “hospitals,” which were adapted to each database.
In addition, a hand search of reference lists of articles was used to
discover publications not identified in the database searches. The
M E TH O D S search results and study selection process are illustrated in Table 1
and Figure 1.
A structured protocol for this review was created a priori by mem-
bers of the review team. The scoping review methodology was se-
lected as it seeks to provide an overview of the scope of existing Study selection
literature and is most appropriate when an extensive body of litera-
ture has not been comprehensively and systematically reviewed. All references were uploaded to Covidence software, and duplicates
The review team for this approach included healthcare providers were removed. Articles were included if they described original work
with decades of clinical practice experience and expertise in EBP, im- where an EBP was implemented and measured patient outcome(s).
plementation science (IS), and systematic review methodology. The Articles that did not discuss patient outcomes were excluded (i.e.,
process and criteria for this scoping review followed the procedures clinician outcomes). Review articles, commentary or editorial, ab-
outlined by Grant and Booth (2009), and the findings are reported stracts, and conference proceedings were excluded.
DOI: 10.1111/wvn.12621
REVIEW ARTICLE
Evidence-based practice improves patient outcomes and
healthcare system return on investment: Findings from a
scoping review
Linda Connor PhD, RN, CPN, EBP-C1 | Jennifer Dean DNP, RN, APRN, EBP-C,
AGACNP-BC | Molly McNett PhD, RN, CNRN, FNCS, FAAN1 | Donna M. Tydings DNP,
1
RN, CNS-BC2 | Amanda Shrout DNP, RN, CCNS, CEN3 | Penelope F. Gorsuch DNP, RN,
NEA-BC, FACHE4,5 | Ashley Hole MSN, RN, FNP-BC, CPON6 | Laura Moore DNP, RN,
APRN, FNP-C7 | Roy Brown MLIS, AHIP8 | Bernadette Mazurek Melnyk PhD, APRN-CNP,
EBP-C, FAANP, FNAP, FAAN1 | Lynn Gallagher-Ford PhD, RN, EBP-C, NE-BC, DPFNAP,
FAAN1
1
Helene Fuld Health Trust National
Institute for Evidence-Based Practice in Abstract
Nursing & Healthcare, College of Nursing,
Background: Evidence-based practice and decision-making have been consistently
The Ohio State University, Columbus,
Ohio, USA linked to improved quality of care, patient safety, and many positive clinical outcomes
2
St. John Fisher University, Wegmans in isolated reports throughout the literature. However, a comprehensive summary
School of Nursing, Rochester, New York,
USA
and review of the extent and type of evidence-based practices (EBPs) and their as-
3
Sinai Hospital, Baltimore, Maryland, USA sociated outcomes across clinical settings are lacking.
4
Summa Health System, Akron, Ohio, USA Aims: The purpose of this scoping review was to provide a thorough summary of
5
The Ohio State University, College of published literature on the implementation of EBPs on patient outcomes in healthcare
Nursing, Columbus, Ohio, USA
6 settings.
Memorial Sloan-Kettering Cancer Center,
New York, New York, USA Methods: A comprehensive librarian-assisted search was done with three databases,
7
Family CareX, Denver, Colorado, USA and two reviewers independently performed title/abstract and full-text reviews
8
Affiliate Faculty, VCU Libraries, Health within a systematic review software system. Extraction was performed by the eight
Sciences Library, Virginia Commonwealth
University School of Nursing, Richmond, review team members.
Virginia, USA Results: Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria.
Correspondence Most articles (63.3%) were published in the United States, and 90% took place in the
Linda Connor, Helene Fuld Health Trust acute care setting. There was substantial heterogeneity in project definitions, designs,
National Institute for Evidence-Based
Practice in Nursing & Healthcare, The and outcomes. Various EBPs were implemented, with just over a third including some
Ohio State University, College of Nursing, aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19%
Columbus, OH, USA.
Email: measured return on investment (ROI); 94% showed a positive ROI, and none showed
a negative ROI. The two most reported outcomes were length of stay (15%), followed
[Correction added on August 28,
2023, after first online publication: by mortality (12%).
The Supplemental References file has
now been provided in the Supporting
Information.]
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in
any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. Worldviews on Evidence-based Nursing published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.
6 |
wileyonlinelibrary.com/journal/wvn Worldv Evid-Based Nu. 2023;20:6–15.
, EVIDENCE-BASED PRACTICE IMPROVES PATIENT OUTCOMES AND HEALTHCARE SYSTEM
|
17416787, 2023, 1, Downloaded from https://sigmapubs.onlinelibrary.wiley.com/doi/10.1111/wvn.12621 by EBMG ACCESS - KENYA, Wiley Online Library on [16/04/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
RETURN ON INVESTMENT: FINDINGS FROM A SCOPING REVIEW 7
Linking Evidence to Action: Findings indicate that EBPs improve patient outcomes
and ROI for healthcare systems. Coordinated and consistent use of established no-
menclature and methods to evaluate EBP and patient outcomes are needed to effec-
tively increase the growth and impact of EBP across care settings. Leaders, clinicians,
publishers, and educators all have a professional responsibility related to improving
the current state of EBP. Several key actions are needed to mitigate confusion around
EBP and to help clinicians understand the differences between quality improvement,
implementation science, EBP, and research.
KEYWORDS
evidence-based decision making, evidence-based practice, healthcare, patient outcomes,
patient safety, return on investment
I NTRO D U C TI O N in congruence with the checklist for Preferred Reporting Items
for Systematic reviews and Meta-Analyses extension for Scoping
Background Reviews (PRISMA-ScR; McGowan et al., 2020; Tricco et al., 2018).
The Covidence systematic review software was used for all stages
It has been three decades since evidence-based practices (EBPs) of the review, including title and abstract screening, full-text review,
were first introduced in the healthcare literature (Evidence-Based and data extraction.
Medicine Working Group, 1992). EBP is the recognized and desired The primary research question was, “When patients receive
standard for international transdisciplinary healthcare providers and care based on evidence, what are the outcomes?” The secondary
is supported by national, international, and professional healthcare research question was, “What type, frequency, and characteristics
organizations and regulatory agencies, such as the American Nurses of EBPs were published in peer-reviewed journals?”
Credentialing Center (ANCC, 2022), the American Nurses Association
(ANA, 2022), the Centers for Disease Control and Prevention
(CDC, 2021), the National Academy of Medicine (NAM, 2022). The Electronic search
goals of evidence-based decision-making (EBDM) are to reduce
variations in practice, enhance the quality of care, improve patient A medical librarian conducted a systematic search for published
outcomes, and reduce costs (Melnyk & Fineout-Overholt, 2019). English-language literature and searched the reference lists for
Numerous articles have been published on EBP, and many EBP guide- additional publications to identify published papers addressing
lines are available to guide much of the care clinicians provide. The EBP and patient outcomes. The databases searched were OVID
underlying assumptions of EBP are that EBPs result in better patient MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied
outcomes and are associated with reducing errors, risks, and costs. Health Literature (CINAHL). These databases were searched from
However, to our knowledge, there has been no comprehensive re- 1992 through July 5, 2020. We chose 1992 because this is when
view of the breadth and depth of EBPs implemented and their impact evidence-based medicine (EBM) was first introduced in the litera-
on outcomes across settings and populations. Therefore, this scoping ture. The search used a combination of keywords and controlled
review aimed to determine the frequency, type, characteristics, and vocabulary for the concepts addressing “evidence-based practice,”
outcomes of EBPs implemented in healthcare settings. “outcomes,” and “hospitals,” which were adapted to each database.
In addition, a hand search of reference lists of articles was used to
discover publications not identified in the database searches. The
M E TH O D S search results and study selection process are illustrated in Table 1
and Figure 1.
A structured protocol for this review was created a priori by mem-
bers of the review team. The scoping review methodology was se-
lected as it seeks to provide an overview of the scope of existing Study selection
literature and is most appropriate when an extensive body of litera-
ture has not been comprehensively and systematically reviewed. All references were uploaded to Covidence software, and duplicates
The review team for this approach included healthcare providers were removed. Articles were included if they described original work
with decades of clinical practice experience and expertise in EBP, im- where an EBP was implemented and measured patient outcome(s).
plementation science (IS), and systematic review methodology. The Articles that did not discuss patient outcomes were excluded (i.e.,
process and criteria for this scoping review followed the procedures clinician outcomes). Review articles, commentary or editorial, ab-
outlined by Grant and Booth (2009), and the findings are reported stracts, and conference proceedings were excluded.
