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Barwon Health Library Service: Evidence Based Practice in Health

Evidence for Excellence

Why is Evidence Based Practice Important

By using Evidence Based Practice you are aiming to provide the most effective available best practice care to improve your patient outcomes.

The evidence by itself does not make the decision but it can help support your patient care process

EBP can be used at an institutional level to inform decisions for things like practice guidelines, while individual clinicians can use EBP to make informed decisions for specific patient care

What is Evidence Based Practice

Evidence based practice is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research[1]

Applying Evidence Based Practice

The complete practice of EBM comprises of 5 steps:

  1. Converting the information need (about prevention,diagnosis, prognosis, therapy, causation, etc) into an answerable question
  2. Tracking down the best evidence in which to answer that question
  3. Critically appraising the evidence  for validity (closeness to the truth), impact (size of the effect) , and applicability (usefulness in out clinical practice)
  4. Integrating the critical appraisal with our clinical expertise and with our patient's unique biology, values, and circumstances 
  5. Evaluating your effectiveness and efficiency in executing steps 1-4, and seeking ways to improve them for next time [2]

Searching for Evidence Based Literature

Searching for Literature

Constructing a well-built clinical question can lead directly to a well-built search strategy.

When you are unsure where to start PICO is a good guide to help you break down your clinical question into key concepts to develop your search strategy. Your PICO should help you choose keywords and key phrases for your search. 

  • P - Patient/Problem – characteristics of patient/ what is the condition or disease
  • I – Intervention/exposure – what do you want to do with the patient
  • C - Comparison (if any) – what is the alternative to the intervention – placebo/different drug/surgery
  • O – Outcome
  • May add T – type of question – diagnosis/Harm, Therapy, prognosis, prevention, and/or S – study – what would be the best study design/methodology
  • Note that you may not use all the information in PICO or well-built clinical question in your search strategy.

You can also consider alternatives to PICO. including SPIDER, COPES, ECLIPSE, PIPOH, PECODR etc) based on field of study (eg: medicine, OT, social work, speech pathology, oncology etc).

Kloda LA., Bartlett JC (2014) Formulating Answerable Questions: Question Negotiation in Evidence-based Practice. Journal of the Canadian Health Libraries Association / Journal De L’Association Des Bibliothèques De La Santé Du Canada, 34(2), 55-60. 

Library Evidence Based Practice Resources

The library has a wide range of  print books, eBooks, and  eJournals about Evidence Based Practice:

Resources for searching for evidence based literature

Evidence Based Literature

Literature that is trustworthy has been appraised for their validity (truth, or reliability in results) and applicability ( that is usefulness in clinical practice). Not every research article published has high levels of validity and applicability so looking for a few things within the article itself can help you determine if the article is suitable for use as a source.

  • Peer reviewed - can be more trustworthy if it has been appraised by professionals in the field
  • Validity of the study or data - what was the chance of bias, can the data and theories apply to other situations or people?
  • Research method used - does the method ensure rigor and trustworthiness?
  • Source of the literature - is it from a reputable source?

Hierarchy of research evidence [3]

Joanna Briggs Institute has developed some Critical Appraisal Tools  which contains checklists to critically appraise the different  studies and reviews 

References

[1]. Sackett, D., Rosenberg, W., Gray, J., et al. (1996). Evidence based medicine: what it is and what it isn't: it's about integrating individual clinical expertise and the best external evidenceBMJ, 312, 71-72. doi: http://dx.doi.org/10.1136/bmj.312.7023.71

[2]. Straus, S., Glasziou, P., Richardson, W., & Haynes, R. (2019). Evidence-based medicine: how to practice and teach it (5th ed.). Edinburgh: Elsevier

[3]. EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved. Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.