Evidence-Based Practice

The first step of the EBP process is developing an answerable question from your clinical case.  The most effective way to create this question is using the PICO format.  PICO is an acronym for the important parts of a well-designed clinical question.  It will help you formulate your search strategy by identifying the key concepts that can be used as search terms, so don't skip this part of the process - it will only make the next step more difficult.

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Population

How would you describe a group of patients similar to yours?  What are the most important characteristics of your patient?  Is your population hospital administration or nursing educators?

Intervention (Exposure, Prognostic Factor)

What main intervention are you considering?  What do you want to do with this patient?

Comparison

What is the main alternative being considered?  Sometimes this is not applicable or is the absence of intervention.

Outcome

What are you trying to accomplish, measure, improve, or affect?

Additional Letters

Timeframe

Is there a time when the intervention should begin or end?

Type of Study

Options include systematic review, randomized control trial (RCT), cohort study, and case control.

Setting

Is there a specific location (medical facility, patient's home, etc.) where the intervention will occur?

Primary Question Types

• Therapy: which treatment is the most effective, or what is an effective treatment for a particular condition
• Diagnostic tests: how to select a diagnostic test, or interpret the results of a particular test, based on its precision, accuracy, acceptability, expense, safety, etc.
• Prognosis: what is the patient's likely course of disease, or how can you screen for or reduce risk
• Harm / Etiology: are there harmful effects of a particular treatment, or how can you avoid harmful effects

Other Question Types

• Clinical findings: how to properly gather and interpret findings from the history and physical examination
• Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses
• Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment
• Prevention: how can a patient's risk factors be adjusted to help reduce the risk of disease
• Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and understand how this meaning influences their healing

The type of question being asked will usually dictate the study design.