Evidence based practice (EBP), also known as evidence based medicine, has been suggested as a more suitable basis for decision-making in clinical practice than the traditional ‘expert' based approach. Central to EBP is the application of evidence (as found in the published literature) to an individual clinical problem. EBP, however, has limitations that may raise questions regarding its applicability to particular types of clinical situations including many of the problems encountered in Emergency Medicine. This article discusses the background and limitations of EBM and suggests some ways that the principles can be incorporated into Emergency Medicine practice.
Evidence-Based Medicine Working Group.Evidence-based medicine: a new approach to teaching the practice of medicine.JAMA1992; 268(17): 2420–5.
2.
AntmanE.M., LauJ., KupelnickB.A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts, Treatment for myocardial.JAMA1992; 268(2): 240–8.
3.
McKibbonK.A., WilczynskiN., HaywardR.S., Walker-DilksC.J., HaynesR.B.The medical literature as a resource for evidence b ased care. Working Paper 1995, Health Information Research Unit (Medline Studies), McMaster University, Ontario, Canada.
4.
SternJ.M., SimesR.J.Publication bias evidence of delayed publication in a cohort study of clinical research projects.BMJ1997; 315(7109): 640–5.
MoherD., OlkinI.Meta-analysis of randomised controlled trials: a concern for standards.JAMA1995; 274(24): 1962–4.
7.
TonkinA.M., AroneyC.N.Guidelines for managing patients with unstable angina Rating the evidence and rationale for treatment.Med J Aust1997; 166(12): 644–7.
8.
NaylorC.D.Grey zones in clinical practice: some limits to evidence-based medicine.Lancet1995; 345(8953): 840–2.
9.
FreemantleN., GrilliR., GrimshawJ., OxmanA.Implementing findings of medical research: the Cochrane Collaboration on Effective Professional Practice.Qual Health Care1995; 4(1): 45–7.
10.
HainesA., JonesR.Implementing findings of research.BMJ1994; 308(6942): 1488–92.
11.
LomasJ.Teaching old (and not so old) docs new tricks: effective ways to implement research findings. CHEPA Working Paper Series No. 93–4, 1993. McMaster.
12.
CarleyS.D., Mackway-JonesK., JonesA.Moving to wards evidence based emergency medicine: use of a structured critical appraiasal journal club.J Accid Emerg Med1999; 15(4): 220–2.
13.
Mackway-JonesK., CarleyS.D., MortonR.J.The best evidence topic report: a modified CAT for summarising the available evidence in emergency medicine.J Accid Emerg Med1999; 15(4): 222–6.
14.
ChalmersI., DickersinK., ChalmersT.C.Getting to grips with Archie Cochrane's agenda.BMJ1992; 305(6857): 786–8.
15.
NHS Centre for Reviews and Dissemination, University of York.Information Sheets1–6, 1995.
16.
MulrowC.D.Rationale for systemic reviews.BMJ1994; 309(6954): 597–9.
