EBP Project, Part 6: Synthesis Table

Purpose: To facilitate synthesis across the body of evidence to answer the clinical question and determine if there is sufficient evidence to support a practice change.

Directions:

Using the information extracted in your evidence table, you will synthesize the information by determining the quantity of evidence based on the Level you’ve assigned, evaluate consistency across findings, and assess applicability to your population and feasibility to the organization. Finally, you will appraise the strength of the overall evidence to guide a practice recommendation. See the grading rubric embedded in Brightspace.

Instructions:

1. Complete column 2 titled “# of Sources” by entering the number of articles for that Level of Evidence.

2. Complete column 3 titled “Consistency” by evaluating how consistent the findings were for all articles at that Level of Evidence. Did they all come to the same or similar conclusions/recommendations?

3. Complete column 4 titled “Findings” by reviewing the findings for all articles at that Level of Evidence.

• Include only statements that directly answer the PICO question.
• Summarize and synthesize findings within each level of evidence. This may require you to make a judgement on conflicting evidence from each study within the level.

4. For the row titled “Fit/Applicability,” enter a narrative explanation on how the practice change is applicable to (or “fits”) your population and the needs of the agency. Consider the following:

• Is the evidence relevant to the population in your PICO question?
• Are resources and support available to implement the intervention? Consider the amount of time for training, length of training, supplies, and other resources that would need to be used. This should be based on critical thinking about the resources and limits of current healthcare agencies.

5. For the row titled “Recommendation,” synthesize the Level of Evidence + the Consistency of Findings + Applicability to recommend (or not recommend) a practice change. Include a narrative explanation on why you have chosen that option. Use the following as a guide:

• Option 1: strong evidence, consistent results, high applicability: Solid indication for a practice change is indicated.
• Option 2: good evidence, consistent results, moderate to high applicability: Consider pilot of change or further investigation.
• Option 3: Good but conflicting evidence, moderate to low applicability: No indication for practice change; consider further investigation for new evidence or develop a research study.
• Option 4: Little or no evidence, no applicability: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue project.
• If you selected either the 1st option or the 2nd option, full or pilot implementation is indicated. If not, implementation is not indicated.

Note about your recommendations:

When evidence includes multiple studies of Level 1, 2, and 3 evidence, there is a similar population or setting of interest, and there is consistency across findings, EBP teams can have greater confidence in recommending a practice change. However, with a majority of Levels 4, 5, 6 evidence, the team should proceed cautiously in making practice changes. In this instance, recommendation(s) typically include completing a pilot before deciding to implement a full-scale change.

Generally, practice changes are not made on Level 4, 5 or 6 evidence alone. Nonetheless, EBP teams have a variety of options for actions that include, but are not limited to: creating awareness campaigns, conducting informational and educational updates, monitoring evidence sources for new information, and designing and conducting research studies.