A Multidisciplinary Intervention Fosters Dissemination and RAPID Implementation of Evidence Based Medicine

Research regarding the promotion of evidence based medicine (EBM) suggests that a common barrier to the transition from knowledge acquisition to implementation may be a lack of acceptance from other members of the multidisciplinary healthcare team.  A needs assessment conducted on our Pediatric Blood and Marrow Transplantation (PBMT) unit suggested that a journal club would be an effective method to promote EBM.  A multi-disciplinary journal club (MJC) was introduced to: (i) promote new, valid and relevant evidence into the clinical pipeline; (ii) reduce barriers to implementation of new innovations associated with lack of multidisciplinary collaboration; (iii) foster multidisciplinary communication; (iv) generate new ideas for research; (v) promote EBM.  Each month, 3 presenters discussed articles related to their individual scope of practice, related to PBMT.  Articles were screened for relevance, innovation and validity by members of a MJC committee.  Attendees/presenters included PBMT team members and members of healthcare teams which frequently interact with PBMT.  A group discussion followed each presentation with regard to relevance, applicability and implementation of innovations presented.  A survey was conducted after 7 consecutive MJCs to determine its impact.  Characteristics of attendees (n=53) and presenters (n=19) are shown in Table 1.  100% of PBMT physicians, hospitalists, social workers, nurse practitioners and child life specialists and 50% PBMT nurses attended more than one MJC.  Results of the impact survey demonstrated that 90% of respondents (n=21) “thought the articles presented were relevant to their clinical practice.” 67% reported that they gained new insights by attending MJC and could identify specific ways to apply concepts discussed.  At least six innovations were implemented (changes in practice [n=3] and multidisciplinary research proposals [n=3]) over seven months, as a direct result of articles presented at MJC (Table 1).  Most successfully implemented innovations involved collaboration between multidisciplinary team members. Promotion of EBM can be achieved by a multidisciplinary approach.  A MJC allows for rapid implementation of innovation by promoting more simultaneous acceptance from all members of the multidisciplinary healthcare team. 

Table 1:  Characteristics of MJC attendees/presenters.

Multi-disciplinary team member	Past Attendees  (n=53)	Past Presenters (n=19)	Upcoming presenters (n=15)	EBM innovations implemented (n=3)	Innovative research proposed (n=3)
Blood Bank			1
Chaplain			1
Dietitian		0	1
PBMT Attending Physician	4	1	1	1*^#	1
PBMT Hospitalist	4	1	2
PBMT Child-Life Specialist	1	0	1
PBMT Nurse	31	7	5	1^
PBMT Nurse Practitioner	4	4	1	1*	1+
PBMT Pharmacist	1	1		1#
PBMT Social Worker	2	2			1
Pediatric Hematology-Oncology Fellow	3	1	1
Palliative Care	2	1			1+
Psychologist	1	0	1

+^*# indicates collaboration