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Critical Care Medicine

Library resources and services especially for critical care medicine

What is Evidence Based Practice (EBP)

Evidence-based practice (EBP) is the process of collecting, processing, and implementing research findings to improve clinical practice, the work environment, or patient outcomes. It is a problem solving approach to clinical practice that incorporates high-quality evidence from well-designed studies along with the patient's values and desires, and the clinician's knowledge and expertise to make decisions about a patient's care.

 

EBP Venn Diagram

Image: Evidence Based Practice Resources Subject Guide, UC Davis Libraries, https://www.library.ucdavis.edu/guide/ebp-resources/

 

MSK achieved Magnet® recognition on February 17, 2016. A significant aspect of Magnet® is that nursing care must be rooted in evidence-based practice. MSK's N-CARE Program fulfills part of the evidence-based practice philosophy by requiring nurses to complete evidence-based clinical research questions based on the PICO(T) framework.

The 7 Steps of EBP

7-Step EBP Process

Image: Cultivating Curiousity Module, McGill University Libraries, https://www.youtube.com/watch?v=C8VCu-peFm4

 

Step 0 - Cultivate a spirit of inquiry within an EBP culture and environement

Step 1 - Ask the burning clinical question in PICOT format

Step 2 - Search for and collect the most relevant best evidence

Step 3 - Critically appraise the evidence (i.e. rapid critical appraisal, evaluation, synthesis, and recommendations)

Step 4 - Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change

Step 5 - Evaluate outcomes of the practice decision or change based on evidence

Step 6 - Disseminate the outcomes of the EBP decision or change

Source: Melnyk BM. Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare : A Practical Guide to Improving Quality, Safety, and Outcomes. ; 2016. (Table 1.2, p. 11)

EBP Steps

PICO(T) is a mnemonic that stands for:

PATIENT/PROBLEM/POPULATION

INTERVENTION

COMPARISON

OUTCOME

(TIME)

Are you working on a evidence based project or N-CARE project?
 
Use the PICO(T) format to frame your question.
  • Population/ Patient Problem: Who is your patient? (Disease or Health status, age, race, sex) / What is the problem?
  • Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications)
  • Comparison: What is the alternative to your plan? (ie. No treatment, different type of treatment, etc.)
  • Outcome: What outcome do you seek? (Less symptoms, no symptoms, full health, etc.)
  • Time:  What is the time frame? (This element is not always included.)
 
Your PICO(T) question will fall under one of these types:
  • Therapy/Prevention
  • Diagnosis
  • Etiology
  • Prognosis
Creating a Search

This easy-to-follow tutorial from the Librarians at the Bodleian Library at Oxford University, in partnership with the Centre for Evidence Based Medicine (CEBM), walks you through an example turning search terms into a search strategy.

This easy-to-follow tutorial from the Librarians at the Bodleian Library at Oxford University, in partnership with the Centre for Evidence Based Medicine (CEBM), walks you through an example turning your search strategy into results. this is a detailed demonstration of using many of the basic and advanced features of PubMed.

What are the Levels of Evidence?

In order to make medicine more evidence-based, it must be based on the evidence found in research studies with higher quality evidence having more of an impact than lower quality evidence. Evidence is ranked on a hierarchy according to the strength of the results of the clinical trial or research study. The strength of results can be impacted by a variety of factors such as the study design, outcomes, and bias, as well as the results themselves.

Hierarchy of Evidence
Level I - Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs)
Level II - Evidence obtained from well-designed RCTs
Level III - Evidence obtained from well-designed controlled trials without randomization
Level IV - Evidence from well-designed case-control and cohort studies
Level V - Evidence from systematic reviews of descriptive and qualitative studies
Level VI - Evidence from single descriptive or qualitative studies
Level VII - Evidence from the opinion of authorities and/or reports of expert committees
Source: Melnyk BM. Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare : A Practical Guide to Improving Quality, Safety, and Outcomes. ; 2016. (Table 1.1, p. 11)
Study Design Tree

Study Design Tree

Q1. What was the aim of the study?
To simply describe a population (PO questions) 
  • Descriptive
To quantify the relationship between factors (PICO questions) 
  • Analytic
 
Q2. If analytic, was the intervention randomly allocated?
Yes? 
  • RCT
No?
  • Observational study

For observational study the main types will then depend on the timing of the measurement of outcome, so our third question is:

 
Q3. When were the outcomes determined?
Some time after the exposure or intervention?
  • Cohort study (‘prospective study’)
At the same time as the exposure or intervention?
  • Cross sectional study or survey
Before the exposure was determined?
  • Case-control study (‘retrospective study’ based on recall of the exposure)

Source: Centre for Evidence Based Medicine: Study Designs. https://www.cebm.ox.ac.uk/resources/ebm-tools/study-designs

Evidence Based Practice Resources