A diagnostic survey reaffirmed therapist's lack of confidence in EBP. Formative interviews (n = 5) found an over reliance on professional craft and personal knowledge. Research knowledge was not included in participants' construct of a good practitioner and engagement in higher order critical reflection was limited. Collaborative learning groups (n = 6) embedded in practice integrated research, theory, practice and critical reflection. Supported by the collegial learning environment, a learning package developed participants' confidence and competence in consuming published research. Summative interviews (n = 5) evaluated the group and found that therapists were empowered to incorporate propositional knowledge into their clinical reasoning, engage in critical reflection and challenge their practice. They felt confident to incorporate EBP into their continuing professional development plans. Sustainability of these changes requires commitment from the therapists and the workplace.

The emphasis on the effective and efficient use of finite resources within acute hospitals has led to close attention being paid to the length of patients' hospital stay and the assessment of risk in facilitating timely hospital discharge. Occupational therapy home assessment visits are valued by the multidisciplinary team as a means of assessing a patient's level of function and environmental risk to ensure safe discharge from hospital. Occupational therapists' education and training and experience mean that they are well placed to predict levels of function postdischarge and to anticipate any problems that may occur in activities of daily living. However, for patients the home assessment visit can be a stressful and bewildering experience. The short-term focus on equipment provision combined with limited postdischarge intervention may not meet patient and carer expectations or concerns with longer-term issues. Although there is a body of evidence to support this intervention, the requirement for evidence-based practice means that there is a need for additional research around the areas of optimal timing, selection of patient groups, therapist's rationale, patient and carer perspectives and any effect that home assessments may have on readmission rates. This paper discusses the literature in relation to the practice of home assessment visits from the acute setting.

Evidence based health care: an open learning resource for health care practitioners. Unit 4: Acting on the evidence. London: IBT Global, 34. de Clive-Lowe S (1996) Outcome measures, cost-effectiveness and clinical audit: the importance of standardised assessments to occupational therapists in meeting these new demands.

There are increasing demands on professionals within health care to provide a service that meets the needs and expectations of patients. This requires the patient to be placed at the centre of the care pathway. Occupational therapy is well placed to contribute to this change in emphasis because of its fundamental client-centred philosophy. Experience has shown, however, that the realisation of these aims has been a challenge for all health care professionals. Increasingly, the National Health Service is drawing upon expertise from outside and, in particular, the quality improvement tools that are used within industry. This article explores the use of the traditional quality tool of process mapping in the evaluation and review of occupational therapy processes. The use of this tool is explained in relation to a clinical audit within a medical admissions unit. The results of the process mapping exercise, and the associated audit that was undertaken, demonstrated the value of the approach. In particular, process mapping enabled the occupational therapy service to evaluate systematically the service being provided and to visualise the optimum pathway of care.