Practicing evidence-based surgery

Abstract

Evidence-based medicine provides a systematic approach to ensuring the delivery of the highest quality of care possible to patients. It draws on the best evidence available to inform the practice of skilled and experienced clinicians. The quality of the evidence ranges from useful but potentially biased single-case studies to randomized clinical trials that meet the strictest standards of scientific rigor. Additional useful evidence can be obtained from meta-analyses, outcome studies, and practice guidelines. Evidence-based medicine has five core tenets for practicing medicine: • Clinical decision making should be based on the best available scientific evidence. • The clinical problem, rather than the habits or protocols, should determine the type of evidence to be sought. • Identifying the best evidence means thinking informed by epidemiologic and biostatistical methods. • Conclusions derived from identifying and critically appraising evidence are useful only if put into action in managing patients or making healthcare decisions. • Performance should be constantly evaluated. The evidence-based medicine algorithm for delivering quality patient care contains five clinical objectives: 1. Achieving a diagnosis 2. Estimating the prognosis 3. Deciding on the best therapy 4. Determining harm 5. Providing care of the highest quality Application of the five core tenets of evidence-based medicine to the five clinical objectives promotes the optimal practice of surgery. The acronym for developing an effective question to guide the application of evidence to the practice of surgery is PICO: patient problem, intervention, comparison intervention, and outcome of clinical interest. Three "pearls" to keep in mind: • Clinical wisdom is invaluable but never above question. • The best evidence is only as good as the clinician who applies the information to deliver patient care. • Clinical acumen and experience form the essential base on which the practice of evidence-based medicine rests.© Springer Science+Business Media, Inc. 2005.