What is Evidence-based Medicine?
Image source: https://health.ucdavis.edu/cnr/evidence_based_practice.html
The most commonly used definition for EBM is that
"Evidence-based medicine 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."
Provided by David Sackett et al in the 1996 article, " Evidence-Based Medicine: What it is and what it isn't" for BMJ. Full text here
The 5 As
The 5 "A's" will help you to remember the EBP process:
- ASK: Information needs from practice are converted into focused, structured questions.
- ACCESS / ACQUIRE: The focused questions are used as a basis for literature searching in order to identify relevant external evidence from research.
- APPRAISE: The research evidence is critically appraised for validity.
- APPLY: The best available evidence is used alongside clinical expertise and the patient's perspective to plan care.
- ASSESS / AUDIT: Performance is evaluated through a process of self reflection, audit, or peer assessment.
Please note, there are several models for EBP with various named and numbered steps. This guide will detail the first three steps ASK, ACCESS/ACQUIRE, APPRAISE. Some models include a 6th step for DISSEMINATE.
* This box and graphic was created by Diane Giebink-Skoglind of ThedaCare. Used by permission. The graphic is adapted from Melnyk, BM & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best pracatice. (2nd ed.) Philadephia: Wolters-Kluwer/Lippincott Williams & Wilkins.
The Funnel vs. the Pyramid
Image used by permission.
"Evidence-based practice needs an update. To that end, this is the fifth article in our Journal of PeriAnesthesia Nursing series revolutionizing processes for evidence-based practice (EBP). The objective of this series is to identify EBP-related traditions that have been in existence for decades, some of which are outdated, while others are not grounded in evidence, and may just add confusion, poor scholarship, and a workload burden. Since the October 2022 issue of the Evidence into Practice column, we have addressed implementation
failure,1 problems with Patients/Problem/Population, Intervention, Comparison, and Outcome (PICO),2,3 and a need for team science in
EBP work.4 The next step in the EBP process involves assembling, appraising, and synthesizing the best evidence.5 In this column, we examine the common practice of grading evidence according to levels in an evidence hierarchy, also referred to as the evidence pyramid"