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EBP Process and PICOT Notes

Steps of the 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: Elements

  • PICOT stands for:
    • P – patient population
    • I – intervention, issue of interest
    • C – comparison
    • O – outcome
    • t – time
  • Purpose: structure a focused clinical question to guide searching and appraisal of evidence
  • Use: frames search strategy and determines relevant study designs

PICOT QUESTION: ICU CHG Example

  • 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
  • Context: ICU patients with central venous catheters; outcome of interest is CLABSI rate; comparison is CHG bath vs soap and water bath

PICOT QUESTION: Pediatric Fever Accuracy Example

  • 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: Diagnosis/Assessment
  • Context: comparison of measurement modalities for fever detection in children

PICOT QUESTION: Type of PICOT Question (Summary)

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

LEVELS OF EVIDENCE AND QUESTION TYPES (Described in the slides)

  • TYPE OF PICOT QUESTION (categories typically used to classify questions):
    • Therapy/Treatment/Intervention
    • Diagnosis/Assessment
    • Prognosis
    • Systematic Review
    • Description (prevalence/incidence)
    • Meaning/Process
  • LEVELS OF EVIDENCE (high to low, with examples):
    • Level 1 – Highest level of evidence
    • Level II for Therapy questions
    • Single Randomized Controlled Trial (RCT)
    • Level II for some Etiology questions
    • Single Non-Randomized Trial (Quasi-Experiment)
    • 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 Fever Accuracy (Revisited)

  • In pediatric patients, is having a tympanic temperature measured, as compared to an axillary temperature measured, more accurate in detecting fever?
  • This question is typically categorized as Diagnosis/Assessment and emphasizes diagnostic accuracy of a measurement method.

PICOT QUESTION: ICU CHG Example (Revisited)

  • 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?
  • This question is typically categorized as Therapy/Treatment/Intervention and focuses on an intervention to reduce an infection outcome.

Practical connections and implications

  • EBP steps provide a framework to translate research into clinical practice by asking clear, answerable questions.
  • PICOT formatting helps target literature searches and improves reproducibility of evidence gathering.
  • Understanding the type of PICOT question guides the choice of study designs to appraise (e.g., RCTs for therapy questions, diagnostic accuracy studies for assessment questions).
  • Recognizing levels of evidence aids in weighing strength of recommendations and identifying where higher-quality data are needed.
  • In real-world practice, these tools support shared decision-making by aligning evidence with patient values, clinical setting, and resource constraints.

Quick reference: key definitions

  • CLABSI: Central line-associated bloodstream infection
  • CHG: Chlorhexidine
  • PICOT components: P, I, C, O, t
  • Time (t): duration over which outcomes are measured

Quick reference: summary of examples

  • ICU example: Therapy/Intervention question comparing CHG bath vs soap and water bath for reducing CLABSI in ICU patients with central venous catheters
  • Pediatric example: Diagnosis/Assessment question comparing tympanic vs axillary temperature for fever detection in children

End of notes