Evidence-based practice is key to providing good health care. Yet, there are large variations in practice among Canadian neonatal intensive care units (NICU) and suitable models for implementing practice change based on evidence and data are lacking. Consequently, Dr. Shoo Lee, Director of the Canadian Neonatal Network, and other members have developed a scientific process of  Evidence-based Practice for Improving Quality  (EPIQ).

EPIQ is:

  • Evidence-based  (it uses published research literature and site data)
  • Targeted  (interventions are based on variations in outcomes)
  • Collaborative (involves the expertise/experience of a national network of clinicians and experts)
  • Continuous (creates culture of continuous quality improvement).


EPIQ evolved out of a 2002-5 study aimed at reducing incidences of nosocomial infection (NI) or Bronchopulmonary Dysplasia (BPD) in 12 tertiary NICUs across Canada (see EPIC[1]).

In the original study NICU sites were assigned to either the NI or BPD group. Members received training in evidence-based practice changes and team building. These new skills were soon applied while assembling interdisciplinary teams, gathering evidence from the literature, targeting specific practices, and implementing the changes. EPIQ teams consisted of Neonatologists, Nurses, Respiratory Therapists, Research Assistants, Dieticians, and members of other disciplines. Practice Changes were implemented using the Plan-Do-Study-Act (PDSA) method. The Coordinating Centre promoted communication within and amongst groups, a critical component of the EPIQ process, via organizing teleconferences, meetings, e-mail discussion groups, and so on.

Through these combined efforts the incidences of both NI and BPD were significantly reduced in both the NI and BPD groups (Lee et al 2008 submitted). Efforts to reduce BPD also significantly reduced NI. Though still being evaluated, we project that the EPIQ process will deliver financial savings to hospitals, for example by reducing the length of infant stay and use of supplemental oxygen.Map of EPIQ sites in Canada


The successes from EPIQ demonstrate how a national network of clinicians, front-line workers, and researchers can engage in a collaborative system that utilizes their cumulative experience and expertise, to encourage evidence-based practice for improving quality. EPIQ is innovative because it establishes a national system for on-going evidence-based quality improvement. In addition to using available published evidence and generating new reviews, EPIQ utilizes objective local and national benchmarked data to identify practices associated with outcome differences for targeted change. This maximizes impact and is more meaningful for individual NICUs. EPIQ may be a model for other areas of health care.

EPIQ Today

Sites across Canada and internationally want to know more about the EPIQ process. Today there are 27 Canadian sites involved in EPIQ.

[1] Evidence-based Practice Identification and Change (EPIC) was renamed in 2007 to Evidence-based Practice for Improving Quality to reflect its quality improvement components.