What is evidence based practice?

"Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett et al, 1996)

Evidence based practice (EBP) means using the best, research-proven assessments and treatments in our day-to-day client care and service delivery. This means each clinician upholds their responsibility to stay in touch with the research literature and to implement best practice as a part of all clinical decision making. Implementing evidence based practice means a real commitment to lifelong learning, expressed in the best possible care for our clients.

EBP as a principle is widely supported in the health sector and is the expected practice in most health professions.

There are a number of EBP processes which have been developed to help clinicians implement EBP in the workplace and some of the websites below explain the steps involved.

The most common procedure follows 6 steps:

Formulate a clinical question
Search the literature
Sort, read and critique the literature
Come to a "clinical bottom-line", in other words recommendations for day-to day practice based only on the best available literature.
Implement the recommendations, documenting them, any changes you choose to make and the outcomes of your intervention. In implementing the recommendations you apply the research to your clinical setting and client. You need to include your client and the service provider in this implementation process. In other words, apply the evidence to the situation in consultation with those who it will affect.
Write up the results.

EBP sounds very time consuming, how can I fit this in?

This is where speechBITE™ becomes a very useful and practical tool. As searching and sorting the literature is very time consuming, we have searched, indexed and rated 1000's of treatment papers for you. This means you can use the speechBITE™ database to make steps 2 and 3 easier and to find relevant papers faster.

There are also a range of other resources available to make the EBP process easier, including already published systematic reviews, critically appraised papers (CAP) and critically appraised topics (CAT). Links to some of these appear below.

In both a systematic review and a CAT someone else has formulated the question, reviewed and critiqued the literature and reported a summarised version of their work. This is a great resource but often you will not be able to find a matching systematic review or CAT and you will have to go through the steps of EBP yourself. Of course if you do a CAT you might like to think about publishing it so that others can benefit from your work. In Australia, the NSW Speech Pathology EBP Network have been working at doing just that. The EBP clinical groups (e.g.: 'Adult Swallowing Group') have already published some CATs and you can read their work on their website.

What does EBP mean to me as a speech pathologist?

EBP is changing the way speech pathologists practice. In the current environment, it is not sufficient to rely solely on what we learnt at University and have picked up along the way since that time. The many stakeholders we now report to are asking us to justify how we provide treatment to our patients and using EBP provides us with real and solid reasons for providing the services we select.

Using EBP means giving the best possible care to our clients and letting go of old or ineffective practices when a different way is possible and effective. It means choosing client focussed service delivery and being able to explain why we should do it that way rather than being compelled to use budget conscious service delivery because we can't prove our treatments are effective.

Where can I get more information on EBP?

These sites contain lots of useful information on EBP:

ASHA EBP technical report (Adobe .pdf document)	ASHA's guidelines for EBP in Speech-Language Pathology and Audiology
NHMRC EBP guidelines	Australian National Health and Medical Research Council guidelines for EBP
Netting the evidence	An overview and tutorial about finding evidence using the net
The Joanna Briggs Institute	The Joanna Briggs Institute is an international research and development organisation specialising in evidence-based resources for healthcare professionals
NSW Speech Pathology EBP Network	Established in 2002 to form a network of Speech Pathologists to share the process of creating clinical questions, collecting and critiquing the evidence, and evaluating its practical application to our clinical practice. There are a range of EBP clinical groups who meet frequently, in which critical appraised papers and topics are developed and discussed, and placed on a website.

David L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott Richardson. Evidence based medicine: what it is and what it isn't. BMJ 1996;312:71-72 (13 January).