Evidence-based practice

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Good surgeons use both individual clinical expertise and the best available external evidence, as neither alone is enough. Without the current best evidence, surgical practice risks becoming rapidly out-of-date to the detriment of patients.

Evidence-based surgery is not restricted to randomised trials and meta-analyses but involves tracking down the best external evidence available to answer clinical questions or problems (see Box 1.1). For example, to find out about the accuracy of a diagnostic test, we need to find proper, cross-sectional studies of patients clinically suspected of harbouring the relevant problem and not a randomised trial. Proper follow-up studies of patients inform about prognosis. Systematic review of several randomised trials (meta-analysis) is much more likely to inform about therapy and whether it does more good than harm.

Evidence-based medicine is a relatively young discipline whose positive impacts are just beginning to be validated, and it will continue to evolve. These days, several undergraduate and postgraduate continuing medical education programmes adopt it and adapt it to their learners’ needs, providing further information and understanding about what evidence-based medicine is and what it is not.

Clinical governance and audit

Patient safety: the WHO surgical safety checklist

This simple yet effective tool has been introduced around the world by the World Health Organisation and is thought to have already saved many lives (Fig. 1.1).

Figure 1.1 The WHO Surgical Safety Checklist

(from The WHO Surgical Safety Checklist, World Health Organisation 2009, with permission.)