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Bedside evidence – is it too late?

In Uncategorized on June 26, 2008 by Alan Lovell Tagged: , ,

Where does evidence belong? An “Evaluation of the Five Most Used Evidence Based Bedside Information Tools in Canadian Health Libraries” suggests that of them (UpToDate, BMJ Clinical Evidence, First Consult, Bandolier and ACP Pier), clinicians preferred UpToDate and Clin Evid even though “neither product generally includes levels of evidence.” The author suggests that if a clinician wished to use these tools then it would be prudent to critically appraise the information they get before using them to guide patient care.

However, these are bedside tools we’re talking about here – there is not time, and indeed is this the place, to start appraising information. Clinicians consistently seem to like UpToDate because it speaks their language and gives relatively detailed guidance on what to do – it’s not really evidence-based, but that does not seem to do it any harm. It does not leave a clinician hanging with a Cochranesque “more research is required”. This is not to criticise Cochrane as it is a fundamentally different beast; surely no-one seriously thinks that Cochrane is suitable for bedside use, or that UpToDate is seriously an evidence-based resource (do they…)?

Arguably, trying to leverage in evidence “at the bedside” is the wrong place to do it; evidence needs to be introduced higher up the chain, where commissioning takes place, where patient-journey pathways are drawn up, where guidance is written and acted upon. We need to be ambitious and get evidence in up at the top. To try and ‘tack on’ a bit of evidence at the bedside is surely too little too late…(?)

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One Response to “Bedside evidence – is it too late?”

  1. Yes, I noticed this one too. I have to say, I still can’t understand the appeal of UpToDate; I tried to use it again today, but the search facility is so stone-aged, I went away head-in-hands.

    There is a real problem with evidence “at the bedside”. You’re so right that more energy needs to go into introducing evidence ‘higher up the chain’ (we’re chipping away at that hard at a local level). But on the other hand, any high-level guidance / pathways are bound, almost be definition, to be pretty generic. Useful for junior staff perhaps, but never ideal for the thorny, unusual, multi-comorbidity problems regularly faced by senior staff on a ward round. Nothing works for these questions except to do a new review of the literature and the only chance to do that well is with a clinical librarian.

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