Flooded with evidence: using a 'spillway' model to improve research implementation in nursing practice

Objective: To identify barriers to implementing evidence‑based practice initiatives in small to medium sub‑acute facilities in Queensland. Design: The study uses a qualitative methodology in which field observations and convergent interviews were employed to generate data. Setting: Four south‑east Queensland sub‑acute care facilities participated in the study. Observational and interview data were collected. Subjects: Field observations were recorded across the sites. Five research fellows collected observational data on evidence‑ based practice implementation across a period of six months. Nine clinicians participated in in‑depth, convergent interviews at the end of the period of observation. Main outcome measures: The authors analysed observational and interview data using qualitative thematic analysis. Results: Three themes emerged which described the needs of clinicians when evidence‑based practice initiatives were being implemented: (1) valuing evidence; (2) risk prioritisation; and (3) controlling the flow of evidence. A ‘Spillway Model’ is proposed as a mechanism for targeting clinical priorities using integrated risk management. Conclusion: This study supports the use of integrated risk management as part of a Spillway Model to guide the introduction of evidence‑based practice initiatives in the clinical setting.