5 Steps of EBP
Use the five "A's" to remember the critical steps of the evidence-based practice process:
ASK the answerable clinical question.
ACQUIRE the most relevant and best evidence to answer the question.
APPRAISE the evidence critically for validity, relevance, and applicability.
APPLY the evidence, along with critical expertise and the patient's preferences and values.
ASSESS the effectiveness and efficiency of the previous four steps and seek ways to improve one's ability to ask, acquire, appraise, and apply.
This guide covers the first 3 steps.
Asking the Question
The "Well-Built Clinical Question"
The first part of any research is identifying the question you want to answer. This is very important because the more you understand your question the more likely you are to obtain relevant results. The process of formulating a good search question is known in evidence-based health care as “the well-built clinical question.”* One way of building your search question starts with the patient and is known as PICO, which stands for:
- P - Patient or Population or Problem/Disease
- Who or what is the question about? This may include the primary problem, disease, or circumstances. Sometimes the sex, age, or race of a patient might be relevant to the diagnosis or treatment of a disease.
- I - Intervention, Exposure or Prognostic Factor
- What main intervention/treatment are you considering? What factor may influence the prognosis of the patient, such as age or comorbidities? What was the patient exposed to?
- C - Comparison(s) or Control
- What alternative intervention are you considering, if any? For example, you might be comparing the efficacy of two medications or the accuracy of two diagnostic tests. Your clinical question does not have to always have a specific comparison.
- O - Outcome(s)
- What are you trying to accomplish or measure? What are you trying to do for the patient or problem? Examples might include managing a disease, alleviating symptoms, preventing a disease, etc.
- T - Timeframe (optional)
- What's the amount of time that you'll be observing the patient or problem. For example, improving rates of hospital-acquired infections over the course of a year.
Also consider the two Ts
Type of Question
- Diagnosis : How to select and interpret diagnostic tests
- Therapy : How to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them
- Prognosis : How to estimate the patient’s likely clinical course over time and anticipate likely complications of disease
- Etiology : How to identify causes for disease, including genetics
Type of Study
Acquiring the Evidence
Primary article databases
Then try these:
Clinical Practice Guidelines
Also consider these specialized resources: