MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- We often hear the terms Evidence-Based Practice (EBP) or Evidence-Based Medicine (EBM), but it's truly important to define this very valuable approach to healthcare in a way that both clinicians and non-clinicians can understand.

Although EBP and EBM are interchangeable, nursing resources more often found for EBP and physician resources for EBM.


So what does it mean?

By definition, it is the conscientious and judicious use of current best evidence, clinical expertise and patient values as tools for quality healthcare delivery. Resources and relevance are also two of the most important factors in this equation. Many times you have high-quality research with proven results, but the next step is to shape the process to facilitate success within your organization. What works at fully resourced private hospitals, may not necessary work here at Madigan!

Historically, it is unclear when this evidence-based movement began, however, the Journal of the American Medical Association published a major article in 1992, with an explosion of EBP literature in the medical community over the next decade.

Today, many successful healthcare organizations and medical centers of excellence have fully embraced EBP in all aspects of their systems and processes.


If EBP is so great, then why isn't it used everywhere, and by everyone?

EBP uses the best possible evidence to guide practice, but research is constantly changing and evolving. What was once the gold standard for managing a critical disease process can quickly be rebuked as new research findings or new technology emerge.

Clinical expertise is the proficiency and judgment that individual clinicians acquire through experience and practice. These skills allow a clinician to recognize when a patient is demonstrating subtle, yet urgent, clinical cues, and when to use certain aspects of standardized EBP protocols without increasing risk from variance.

That expertise is also reflected in more effective and efficient diagnoses and thoughtful and compassionate use of patient rights and preferences when deciding treatment plans. Unfortunately, this essential ingredient is many times absent during medical decision-making.

Executive leadership must endorse EBP's use in order to facilitate quality patient outcomes, but not suppress invaluable clinical freedom. The primary focus must always be our patients, and not the overwhelming desire to cut costs.

EBP is quite simply making healthcare decisions using the best available scientific evidence to deliver quality care and improve our patients' outcomes. The best clinicians use a balance of clinical expertise and best available evidence.

Stay tuned for Part 2 of this series… "Evidence-Based Why?"