How We Incorporate Evidence Into Our Practice

I'm participating in a multisociety task force (ACCP, SCCM, ATS) to develop an approach or a guide to how to incorporate clinical evidence into clinical practice.  The task force met yesterday at the SCCM.  Part of the impetus for the group is the cantankerous point/counterpoint sort of presentations that seem to be occurring with some regularity at national meetings.  Such debates you may have seen over the use of drotrecogin alpha, the use of steroids, degree of glucose control, Hgb administration in severe sepsis, and the list goes on.  One of the things that we are addressing is our current approach to incorporating evidence, with discussion about whether, indeed, placebo-controlled, double-blind, randomized trials trump all other forms of evidence.  We approach the question of when clinical, i.e. physiologic evidence should guide a person to step outside of guidelines, or whether that is ever the case.  We talk about when retrospective evidence is adequate and when it is not.  When we should standardize and when we should not.  And I hope I have convinced others that regardless of how that choice is or was made, that outcomes must be followed, so that we can adjust our care. All of us in the collaborative face decisions every day about what evidence to follow and when and how to do so.  I hope this document and the sessions at various society meetings that will follow will make for some practical help to make those decisions.