GO

Clinical Questions

Steps of the Evidence-Based Practice (EBP) Process

  • Ask a clinically meaningful question
  • Collect the evidence
  • Critically appraise the evidence
  • Synthesize the evidence
  • Integrate evidence with clinical expertise, patient value and preferences, and clinical setting
  • Make a decision and implement
  • Evaluate outcomes

PICOT QUESTION: Structure

  • P – patient population
  • I – intervention, issue of interest
  • C – comparison
  • O – outcome
  • t - time

Example PICOT Question: ICU CHG vs soap and water for CLABSIs

In patients admitted to an ICU with a central venous catheter, does receiving a daily bath with chlorhexidine (CHG), compared to receiving a daily bath with soap and water, affect rates of central line associated bloodstream infections (CLABSIs) while inpatient?

Type of PICOT Question

  • Therapy/Treatment/Intervention
  • Diagnosis/Assessment
  • Prognosis
  • Etiology/Harm
  • Description (prevalence/incidence)
  • Meaning/Process

PICOT Question in Pediatric Patients: Temperature measurement

  • In pediatric patients, is having a tympanic temperature measured, as compared to an axillary temperature measured, more accurate in detecting fever?

TYPE OF PICOT QUESTION (Level and Evidence Mapping)

  • Level 1 – Highest level of evidence
  • Level II for Therapy questions
  • Single RCT
  • Level Il for some Etiology questions
  • Single Non-Randomized Trial (Quasi-Experiment)
  • Etiology/Harm
  • Description (prevalence/incidence)
  • Meaning/Process
  • Single Prospective Cohort Study
  • Single Case-Control Study
  • Level II for Prognosis questions
  • Level II for some Diagnosis questions
  • Single Cross-Sectional Study (e.g., a Survey)
  • Single In-Depth Qualitative Study
  • Level II for Descriptive quantitative questions
  • Level II for Meaning/Process questions
  • Expert Opinion, Case Reports, etc.

PICOT Question: Pediatric Temperature Accuracy (Repeated content)

  • In pediatric patients, is having a tympanic temperature measured, as compared to an axillary temperature measured, more accurate in detecting fever?

LEVELS OF EVIDENCE AND STUDY DESIGNS

  • Level I – Highest level of evidence
  • Level II for Therapy questions
  • Single RCT
  • Level Il for some Etiology questions
  • Single Non-Randomized Trial (Quasi-Experiment)
  • Etiology/Harm
  • Description (prevalence/incidence)
  • Meaning/Process
  • Single Prospective Cohort Study
  • Single Case-Control Study
  • Level II for Prognosis questions
  • Level II for some Diagnosis questions
  • Single Cross-Sectional Study (e.g., a Survey)
  • Single In-Depth Qualitative Study
  • Level II for Descriptive quantitative questions
  • Level II for Meaning/Process questions
  • Expert Opinion, Case Reports, etc.