The EBP modern movement was founded by Archie Cochrane, a British epidemiologist. In his 1972 landmark book, Effectiveness and Efficiency: Random Reflections on Health Services, Cochrane expressed concerns/criticisms of the lack of scientific evidence guiding medical practice in the effectiveness of treatments and appropriate use of resources. He believed that clinical practice decisions should be based on evidence from randomized trials. The need to maintain accurate reviews of all randomized controlled trials related to all medical fields led to the development of the Cochrane Centre in 1992 and eventually the Cochrane Collaboration. —Stavrou, Challoumas, & Dimitrakakis, 2014
David Sackett, M.D. defines evidence-based medicine as follows:
"[It] 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, Rosenberg, Gray, Haynes, & Richardson, 1996
Dr. Sackett's definition is applicable across healthcare disciplines. The figure illustrates the integration of the three components.
The key steps of Evidence-Based Practice include:
| Asking | Converting the clinical puzzle into an answerable question |
| Accessing | Searching to find the best evidence to answer the question |
| Appraising | Critically evaluating the evidence to decide if it is reliable and robust |
| Applying | Extracting useful information to decide what clinical action is best |
| Assessing | Evaluating the process to integrate this element into the quality improvement cycle |
—Duke University Medical Center Library, December 2014; Straus, 2011
This guide addresses the first two steps, "Asking" and "Accessing". For more information on the remaining steps, refer to: the Tutorials and Learning Tools section.