This guide includes a tutorial about Evidence-Based Practice (EBP) in Health, a Reference Shelf of supporting eBooks, and a Toolkit of online sources of evidence.
The goals of the tutorial are to clearly outline the theory of EBP and to explain how that theory can be put to practice in the day-to-day work of caring for patients. The tutorial includes an introduction and modules that follow the "5A's Cycle" of EBP that include assessing the patient and prioritizing questions about his/her care, asking a focused clinical question, acquiring the evidence to answer the question, appraising the research, applying the research findings to patient care, and finally auditing your performance.. The cycle begins again with an assessment of the patient and the patient's care.1
The tutorial focuses largely on efficient literature searching and therefore on asking questions and acquiring the best evidence. In particular, it suggests specific strategies for finding evidence from primary studies, systematic reviews and meta-analyses using EBP tools. Appraisal is also touched upon, with suggestions for scanning search results to identify articles more likely to yield robust, applicable evidence.
At the end of the tutorial, you should be able to:
This tutorial assumes you already have some familiarity with basic and advanced PubMed search techniques, as well as with MeSH searching.
There are many excellent on-line and print guides that address the critical appraisal of a research report and the application of evidence to an individual patient's care. You will find links to selected resources that provide especially rich content in these areas in the Appraise and Apply modules of this tutorial.
It is best to work systematically through the various modules, starting with Introduction: About Evidence-Based Practice, and then the five modules.
The Library has a vast range of books and ebooks about EBP that can be found via Library Search (the Library Catalogue). The Reference Shelf in this guide lists a range of the EBP eBooks and Books by category and discipline area.
The classic definition of Evidence-Based Practice (EBP) is from Dr David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research”.2
EBP has developed over time to now integrate the best research evidence, clinical expertise, the patient's individual values and circumstances, and the characteristics of the practice in which the health professional works.3
So, EBP is not only about applying the best research evidence to your decision-making, but also using the experience, skills and training that you have as a health professional and taking into account the patient's situation and values (e.g. social support, financial situation), as well as the practice context (e.g. limited funding) in which you are working. The process of integrating all of this information is known as clinical reasoning. When you consider all of these four elements in a way that allows you to make decisions about the care of a patient, you are engaging in EBP.4
EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. EBP promotes an attitude of inquiry in health professionals and starts us thinking about: Why am I doing this in this way? Is there evidence that can guide me to do this in a more effective way? As health professionals, part of providing a professional service is ensuring that our practice is informed by the best available evidence. EBP also plays a role in ensuring that finite health resources are used wisely and that relevant evidence is considered when decisions are made about funding health services.4
Before EBP health professionals relied on the advice of more experienced colleagues, often taken at face value, their intuition, and on what they were taught as students. Experience is subject to flaws of bias and what we learn as students can quickly become outdated. Relying on older, more knowledgeable colleagues as a sole information source can provide dated, biased and incorrect information. This is not to say that clinical experience is not important - it is in fact part of the definition of EBP. However, rather than relying on clinical experience alone for decision making, health professionals need to use clinical experience together with other types of evidence-based information.5
Not all research is of sufficient quality to inform clinical decision making. Therefore you need to critically appraise evidence before using it to inform your clinical decision making. The three major aspects of evidence that you need to critically appraise are:
1. Guyatt, G.H., Haynes, R.B., Jaeschke, R.Z., & Cook, D.J. (2000). Users' guides to the medical literature: XXV. evidence-based medicine: principles for applying the users' guides to patient care. JAMA, 284, 1290-1296. doi: http://dx.doi.org/10.1001/jama.284.10.1290
2. 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 evidence. BMJ, 312, 71-72. doi: http://dx.doi.org/10.1136/bmj.312.7023.71
3. Mayer, D. (2010). Essential evidence-based medicine (2nd ed.). Cambridge: Cambridge University Press.
4. Hoffman, T., Bennett, S., & Del Mar, C. (2013). Evidence-based practice: across the health professions (2nd ed.). Chatswood, NSW: Elsevier.
5. Straus, S., Glasziou, P., Richardson, W., & Haynes, R. (2011). Evidence-based medicine: how to practice and teach it (4th ed.). Edinburgh: Churchill Livingstone Elsevier