BUSI 418 Week 3 Discussion Board Forum 4 Example

Discussion Board Forum 4: Appraising Conflicting Evidence

BUSI 418 Research and Evidence Based Practice in Healthcare, Discussion Board Forum 4

Thread by [Student Name]

The hospital and the classmates are composites; the textbook, Scripture and the peer-reviewed articles cited are real.

Our hospital's quality committee is considering a nurse-driven protocol that lets nurses remove urinary catheters without a physician order when no criteria for keeping them apply. The quality team found two studies that seemed to point in opposite directions. Hall and Roussel (2017) explain that appraisal means judging a study's validity, results and applicability, not simply reading its conclusion, so we compared the two carefully, column by column, before anyone voted.

Kamel et al. (2025) reported a pre-post observational study at a 160-bed Veterans Affairs hospital in which the protocol, supported by a multidisciplinary team and a catheter-use dashboard, was followed by catheter-associated infections dropping from just under one per 1,000 catheter days (0.99) to roughly a quarter of one (0.27), and by catheter use falling from 14% to 12% of patient days. Reynolds et al. (2022) implemented a similar protocol across a large academic health system and, using statistical process control charts, found no signal of improvement in catheter use or infection rates, though the protocol was documented about 600 times a month and about 6% of removed catheters were reinserted within 48 hours.

Why the difference? First, both were observational, not randomized, so neither can prove cause. Second, the interventions differed: Kamel paired the protocol with a dashboard and a dedicated team, while Reynolds tested mainly the protocol itself, and its own authors concluded that other interventions should be added. Third, the settings differed in size and culture: a single Veterans Affairs hospital can change a practice quickly, while a large academic system with many units and many physicians changes slowly. Fourth, the outcomes differed, since one study emphasized infection rates and the other catheter use, which do not always move together. Read together, the studies suggest that the protocol helps when it is part of a broader program with visible data, not as a stand-alone policy.

Our recommendation was to adopt the protocol with a dashboard and monthly review, and to track both infections and catheter use so we would know which, if either, changed. Luke commends the Bereans for receiving the message eagerly while still examining the Scriptures daily to see whether it was so (English Standard Version Bible, 2001/2016, Acts 17:11). Two studies that disagree are not a dead end; they are a map of what made the difference.

Reply to Kiara

Kiara, you argued that your clinic should adopt any intervention supported by a randomized trial. Trials are strong evidence, but a single trial can mislead if its setting or population differs from yours, or if the intervention was delivered differently than you would deliver it. Chaiyachati et al. (2018) tested free rideshare transportation for Medicaid patients in a clinical trial and found no reduction in missed appointments, partly because few patients used it, a result that might differ in a clinic where transportation is the main barrier. Oikonomidi et al. (2023) found that the certainty of evidence for some no-show interventions came from only one trial each, which limits confidence. Hall and Roussel (2017) stress applicability as part of appraisal, asking whether the patients, setting and resources in a study resemble one's own. The Bible warns that every matter is established by two or three witnesses (English Standard Version Bible, 2001/2016, Deuteronomy 19:15). Would your clinic look for a second study, or run a small pilot of its own, before changing practice for every patient?

Reply to Owen

Owen, you asked whether systematic reviews can always be trusted, since your manager treats any review as the final word. They sit high in most evidence hierarchies, and for good reason, but their quality depends entirely on the studies they include and on how carefully those studies were found and judged. Busschaert et al. (2025) reviewed 59 studies of time-driven costing in oncology and rated average study quality at only 52%, so a review of weak studies still yields weak conclusions, however carefully the review itself was conducted. Sebire et al. (2025) noted the importance of appraisal skills for managers who use evidence. Hall and Roussel (2017) describe tools for appraising reviews, such as checking how studies were searched and assessed. Proverbs calls the person who finds wisdom and gains understanding blessed (English Standard Version Bible, 2001/2016, Proverbs 3:13), and understanding a review starts with knowing how it was built. How would you check a review's search and quality appraisal before relying on it for a decision that affects patients or budgets?

References

Busschaert, S. L., Werbrouck, A., De Ridder, M., & Putman, K. (2025). The application of time-driven activity-based costing in oncology: A systematic review. Value in Health, 28(4), 643-651. https://doi.org/10.1016/j.jval.2024.11.003

Chaiyachati, K. H., Hubbard, R. A., Yeager, A., Mugo, B., Lopez, S., Asch, E., Shi, C., Shea, J. A., Rosin, R., & Grande, D. (2018). Association of rideshare-based transportation services and missed primary care appointments: A clinical trial. JAMA Internal Medicine, 178(3), 383-389. https://doi.org/10.1001/jamainternmed.2017.8336

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hall, H. R., & Roussel, L. A. (2017). Evidence-based practice: An integrative approach to research, administration, and practice (2nd ed.). Jones & Bartlett Learning.

Kamel, M., Harris, N., Berry, A., Warsavage, T., Bessesen, M. T., & Kon, S. E. (2025). Implementation of a nurse-driven protocol for indwelling urinary catheter removal and novel utilization dashboard: A pre/postintervention observational study. Therapeutic Advances in Infectious Disease, 12, 20499361251317900. https://doi.org/10.1177/20499361251317900

Oikonomidi, T., Norman, G., McGarrigle, L., Stokes, J., van der Veer, S. N., & Dowding, D. (2023). Predictive model-based interventions to reduce outpatient no-shows: A rapid systematic review. Journal of the American Medical Informatics Association, 30(3), 559-569. https://doi.org/10.1093/jamia/ocac242

Reynolds, S. S., Lozano, H., Fleurant, M., & Bhandari, K. (2022). Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters. American Journal of Infection Control, 50(12), 1355-1359. https://doi.org/10.1016/j.ajic.2022.03.005

Sebire, S. Y., Brown, J., Malewezi, E., & Tume, L. N. (2025). Understanding, using, and facilitating evidence-based practice: A scoping review of influencing factors among nurse managers in acute care. Journal of Nursing Management, 2025, 2155376. https://doi.org/10.1155/jonm/2155376