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Evidence-Based Practice: Guidelines & Steps

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson cover the six important steps regarding the evidence-based practice process in a medical practice. You'll learn everything from how to ask the right question to what to do with the evidence you collect.

Evidence-Based Practice

Today, we're going to meet Dr. Holmes, the hypothetical great-great-great grandson of Sherlock Holmes. Like his famous ancestor, he is a detective, but of the medical kind. In medicine, physicians and nurses must always be on the lookout for evidence, clues, and so on. They must critically appraise what they see, learn, and how they apply things in practice.

Let's see what Dr. Holmes can teach us about the proper steps he takes with respect to evidence-based practice (EBP), the concept of conscientiously using the best and latest evidence in order to make the best decisions about patient care.

A Spirit Of Inquiry

Dr. Holmes tells us that the most important thing he learned from the advice passed down to him from Sherlock is that he has to have, first and foremost, a spirit of inquiry. He must support a culture where medical practitioners:

  • Can freely learn about and even challenge the practices and policies within a medical institution.
  • Work within an infrastructure that supports EBP, with teammates that are well-versed in EBP, and an institution that recognizes and rewards individuals who employ EBP.
  • Be evaluated and even promoted via EBP related competencies.

The Steps Of EBP

Luckily, Dr. Holmes already works with a great spirit of inquiry on his own and in his practice. So, he takes some time to show us how he would use the six steps behind the EBP process within the confines of a particular clinical case. It's a case of the missing tooth. But, as with every Sherlock tale, there's a twist. The tooth isn't missing from his patient, a middle aged man named John W. Instead, the tooth is embedded within John's arm, and Dr. Sherlock needs to figure out who's missing it!

The first step of the EBP process is to formulate and ask the most important and pressing clinical question in the PICOT format:

  • 'P'atient population
  • 'I'ntervention or 'I'ssue of interest
  • 'C'omparison intervention or group
  • 'O'utcome
  • 'T'ime frame

Dr. Holmes asks: In middle aged men with an unidentified tooth stuck in their arm (the patient population), how does treatment of an infection stemming from that via antibiotics alone (our experimental intervention) compared to surgical extraction with antibiotics (our comparison intervention) affect survival rates (the outcome) after 2 weeks of treatment (the time frame)?

Asking the question in the PICOT format allows Dr. Holmes to proceed to step 2, the search for the best and most relevant information to the mystery.

After Dr. Holmes searches for all the best evidence, he proceeds to a critical step, step 3. This is where he critically appraised the evidence he's gathered. He ensures the result of the study are valid and that they are relevant to John W's case.

The next step, step 4, is to take the evidence Dr. Holmes has found and integrate it with all of Dr. Holmes' expertise and experience and the patient's preference. Even if Dr. Holmes believes, based on evidence and experience, that surgery is the best option, John may be extremely afraid of surgery because he had a near death experience with an anesthetic drug before. The patient's preferences must then be reconciled with Dr. Holmes' research and professional opinion.

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