Evidence-based practice and health technology assessment: a call for anesthesiologists to engage in knowledge translation

Abstract

How often have senior leaders in your hospital asked you to cut drug and equipment costs? Can we justifiably afford depth of anesthesia monitoring equipment for each operating room? Based on the benefits and risks, is the routine use of inhaled nitric oxide properly justified in patients who experience difficulty in weaning from cardiopulmonary bypass? Healthcare in North America is clearly at a crux. On the one hand, there is the pressing need to do all that we can to justify the increasing costs and efforts expended to implement new drugs, technologies, and techniques into practice. On the other hand, we need to respect that we cannot (and should not) ‘‘do it all’’, especially if the new techniques or technologies will achieve only marginal benefits at best and at greater risk and cost compared with the existing status quo. There is a limit in terms of available resources: money, space, human resources, time, and effort. Evidence-based health technology assessment (EBHTA) is not necessarily a means for cost-cutting, since the best available evidence may suggest that the newest most expensive option is truly the best option, and that the payback is worth the incremental costs required. Thus, EB-HTA provides guidance to ensure that resources are not wasted and that every dollar expended improves value for money. Evidence-based medicine (EBM) is formally defined as the ‘‘conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’’. To practice EBM, all relevant highquality evidence should be sought, even when it does not say what we want it to say. Evidence-based medicine provides tools for filtering and interpreting clinical evidence so that we are less prone to being duped by biased or misleading information that can be cleverly cloaked as scientific evidence. For example, we can use pre-filtered evidence or apply the tips set out by the users’ guides to the medical literature to improve our objectivity in determining: