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Lesson 7
Rapid Critical Appraisal of Evidence©
Debra Jeffs, PhD, RN
LEARNING OBJECTIVE
The learner will be able to: 1) describe the steps of rapid critical appraisal of evidence and 2) differentiate the levels of evidence.
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OVERVIEW
In Lesson 6 you learned about searching the databases to find evidence to answer your PICO question. A hierarchy of the levels of evidence provides an idea of where to start your search for and appraisal of the evidence. The hierarchy offers information about the potential strength of the available evidence. The strength of evidence is based on the quality of the studies’ research design, the quantity of studies, and the consistency among the studies’ findings. Start your search for the evidence with the strongest evidence listed as #1. The levels are:
- EBP Clinical Practice Guidelines (e.g. www.guideline.gov)
- Synopsis of syntheses (e.g. EBP Journals, such as World Views on Evidence Based Nursing; Linking Evidence to Action.)
- Syntheses or Meta-analyses of RCT studies (e.g. Cochrane Reviews)
- Systematic reviews of single randomized controlled studies
- Single well-designed randomized controlled research study
- Systematic reviews of non-randomized controlled trials
- Systematic reviews of observational studies or meta-syntheses of qualitative studies
- Single descriptive or qualitative study
- Expert opinion, expert committees
- If necessary to start with a review of a single research study, then work with your mentor and EBP team in conducting a “rapid critical appraisal” of the evidence.
To determine what is useful and applicable to the problem you have identified, ask these three core questions:
1. What are the results of the study?
Look at the statistics or findings of the study
(with your mentor!!)
2. Are the results valid?
Examine how well the study was
conducted
3. Will the results help me in caring for
my patients?
Identify the application of the study sample
to your own patient population
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Internal evidence generated from within your healthcare organization might also be available and includes:
Quality improvement data
Benchmarking data
Evaluation data.
Collaboration with others is essential in critically appraising evidence or rating the strength of evidence. Preferably, work on a team with your mentor through the appraisal process. Together, examine the evidence available in relation to the hierarchy of evidence. Next, answer each of the rapid critical appraisal questions for each piece of evidence found. Then integrate or synthesize the evidence found. This becomes your evidence-base upon which you will make practice decisions.
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