The role of Knowledge and Library Services in evidence-based practice

About the role of knowledge and library services in evidence-based practice

What is the history of evidence-based medicine?

Libraries and Librarians working in the healthcare sectors have a key role in supporting “evidence-based medicine” (EBM) which is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, 1996).

We may see the above statement as self-evident and take it for granted that the approaches and treatments that are prescribed are based on the best evidence to support the best outcome for us. However, the idea of a systematic application of evidence to reach a clinical decision is a relatively new one, previously the clinician may well have been applying theories that were unproven rather than ones based on evidence.

Several clinicians from the 1950s onwards developed the idea of applying research and evidence in a systematic approach to clinical decisions and interventions. They were interested in what the evidence said to do in any scenario. Individual clinicians such as Alvan Feinstein, Tom Chalmers and Archibald Cochrane working in separate areas developed these methodologies and by the 1990s the term “Evidence based Medicine” was being used to capture this approach (Surr and Dahm, 2011).

EBM and Evidence-Based Practice (EBP) brings together three key aspects of healthcare for a more patient-focused approach: the best available evidence; clinical expertise; and the patient’s own circumstances and expectations (CASP, no date).

The impact of this approach is shown in the establishment of the Cochrane Library in 1993 as part of the Cochrane Project. The Cochrane commissions systematic reviews which pool together research and evidence on topics to make recommendations on best practice. Or in the case of areas where there is limited evidence make recommendations for further trials to establish the evidence.

This has been the case in the use of corticosteroids for acute brain injury, corticosteroids had been regularly given to patients suffering from acute brain injuries despite unclear evidence for its benefit. The identified gap in knowledge led to the commission of the CRASH trial which showed that the intervention caused harm and therefore the practice was stopped (Alderson, 2005).

Health libraries and Librarians work to support the application of Evidence-Based Practice in searching for research articles to support clinical decision making, background for Quality improvement projects and re writing clinical guidelines. Librarians assist with other activities such as the promotion and education of ideas such as the hierarchy of evidence and promote the use of tools to inform clinical decision making. Librarians may also facilitate critical appraisal of research or its synthesis to support Evidence Based Medicine and clinicians’ practice.

What is evidence-based practice and why is it important?

Evidence-Based Practice (EBP) builds on the principles of Evidence-Based Medicine, which was introduced in medical literature in the 1990s as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Guyatt, 1992 and Sackett, 1996).

EBP brings together key areas including evidence-based medicine, evidence-based nursing, and evidence-based healthcare, under one overarching discipline to deliver improved healthcare outcomes and high-quality patient care.

EBP is also supported and encouraged by UK legislation. The UK Health and Social Care Act 2012 stipulates the “use of evidence obtained from research”, placing responsibility on healthcare services to implement and promote the use of evidence-based decision making to improve health services (Section 14(2) Health and Social Care Act 2012).

With this drive to deliver EBP across the NHS, what better way is there for healthcare providers and clinicians to access the evidence than through NHS Knowledge and Library Services?

NHS Libraries are best placed to support healthcare improvements and high-quality patient care by sourcing the best available information.

In fact, the 2021-2026 Knowledge for Healthcare strategic framework from NHS England (Knowledge for Healthcare, 2021) is aimed at NHS Knowledge and Library Services in England. The framework supports healthcare libraries to work towards mobilising evidence; sharing knowledge and improving outcomes.

What are the key aspects of evidence-based practice?

Evidence-based best practice in healthcare, incorporates three central components for a more patient-focused approach, as discussed by Parrott and Dutta (2021, p.230):

• The best available evidence: Patient-centred and clinically relevant research, guidelines, and strategies, underpin an up-to-date knowledge of what’s going on in research and related specialties.
• Clinical expertise and knowledge: Clinicians’ own skills, knowledge, experience, and expertise in identifying individual patient’s needs, diagnoses, and treatments, will in turn guide how they apply these to their patients.
• Patient values and circumstances: Each patient’s individual circumstances and expectations regarding their health, build a personalised picture of what they need from their healthcare experience.

What are the barriers to evidence-based practice and how can health librarians help?

Delivering these central components of EBP takes dedicated time, ready resource access, and information-seeking skills.These are areas where health librarians excel to help already-busy and time-constrained clinicians to bridge the gap between sourcing the best available evidence and taking it to the point of patient care.

Health librarians aim to “provide current, accurate and relevant health information…in dealing with a physician, the primary responsibility to that person is the provision of information” (Lappa, 2004). Health librarians therefore have the trained skills and access required to source relevant information from the healthcare databases and resources. They are invaluable in their contribution to EBP and saving clinician time to be spent with direct patient care.

References and further reading

Alderson, P. and Roberts, I., 2005. Corticosteroids for acute traumatic brain injury. Cochrane Database of Systematic Reviews. Available at:

CASP (no date) What is evidence-based practice? CASP - Critical Appraisal Skills Programme.

Guyatt, G.H., Cairns, H., Churchill, D. et al., 1992. ‘Evidence-based medicine: a new approach to teaching the practice of medicine.’ ACP Journal Club, 114(2), pp.2420-2425.

Health and social care act 2012 (legislation.gov.uk).

Knowledge for Healthcare, 2021. Knowledge for Healthcare Mobilising evidence, sharing knowledge, improving outcomes. Knowledge for Healthcare.

Lappa, E., 2004. Clinical Librarianship (CL): A historical perspective. Electronic Journal of Academic and Special Librarianship, [e-journal] 5(2-3). Clinical Librarianship (icaap.org).

Parrott, R. and Dutta, D. (2021) ‘Evidence-based medicine, clinical guidelines, trustworthiness and safe care in anaesthetics’, in J. Samanta and A. Samanta (eds) Clinical guidelines and the law of medical negligence: multidisciplinary and international perspectives. Cheltenham, UK:Edward Elgar Publishing Limited, pp. 228-251.

Ratnani, I., Fatima, S., Mohsin Abid, M., Surani, Z. and Surani, S. (2023) ‘Evidence-based medicine: history, reviews, criticisms, and pitfalls’, Cureus.

Sackett, D.L. et al, 1996. Evidence based medicine: what it is and what it isn’t. BMJ. 1996 Jan 13; 312(7023): 71–72.

Smith, R., 2014. Evidence based medicine—an oral history. BMJ. 2014 Jan 21; 348: g371.

Sur, R.L. and Dahm, P., 2011. History of evidence-based medicine. Indian Journal of Urology, 27(4), pp.487-489.