The 6 steps of evidence-based decision making

Step	Action	Explanation
1	Transformation of the clinical problem into 3 or 4 part question	(a) relevant patient characteristics and problem(s), (b) leading intervention, (c) alternative intervention, (d) clinical outcomes or goals.
2	Additional step: answer to the question based on “internal evidence” only	Internal evidence: acquired knowledge through professional training and experience (in general and applied to the patient). Should be documented before proceeding to step 3.
3	Finding “external evidence” to answer the question	External evidence: obtained from textbooks, journals, databases, experts. The value of the external evidence will be highly variable, see step 4.
4	Critical appraisal of the external evidence	Should answer 3 questions: (1) Are the results valid? (2) Are the results clinically important? (3) Do the results apply to my patient? (or is my patient so different from those in the study that the results do not apply?)
5	Integrating external and internal evidence	The 2 sources of information (external and internal) may be supportive, non-supportive, or conflicting. How the decision is made when non-supportive or conflicting will depend on multiple factors.
6	Evaluation of decision making process	Once the decision has been made, the process and the outcome are considered and opportunities for improvement are identified.