Evidence-based medicine: What it is, why it’s important in law

© The Medical-Legal News, 2007 

By Kathy Aldridge, MSN, ACM, CPHQ, CLNC

Following clinical guidelines approved by a particular hospital and objective nationally-recognized evidence-based medical care standards will reduce a facility’s liability.

If a case comes to trial, the rules of evidence adopted in 1993 as a result of the Supreme Court ruling in Daubert vs. Merrell-Dow Pharmaceuticals (JAMA 270:423, 1993) state that trial judges are charged with ensuring that a scientific expert’s testimony is relevant and rests on a reliable foundation (JAMA 283:2775-6, 2000).

When reviewing a case, the attorney or legal nurse consultant should evaluate guidelines in use by an organization at the time of the incident and note any deviations from the guideline. The LNC may find that the physician or nurses in question may not utilize evidence-based guidelines that are available, thus increasing both the hospital’s liability and their own personal liability.

Guidelines form part of the evidence base from which practitioners work. They are written on a clearly defined topic or disease process and, after systematic research, use the best available evidence. They should define the search strategy, references used and the reasoning for how the recommendations for care were written. Guidelines should be statements to inform clinicians and patients. Clinicians still have to decide if the guideline is appropriate for a specific patient, and patients still have to agree with the treatment offered.

Guidelines facilitate evidence-based (EBP) practice by attempting to draw together all relevant research on a topic, consider conflicting research and give recommendations for clinical practice to help the clinician and the patient make decisions about treatment options. A useful source of information about available guidelines is the National Guideline Clearinghouse, which is accessible on the internet at www.guideline.gov.

The practice of evidence-based medicine (EBM) means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Individual clinicians acquire proficiency and judgment through clinical experience and clinical practice. Increased expertise is demonstrated by effective and efficient diagnosis and by thoughtful identification and use of individual patients’ predicaments, rights and preferences in making clinical decisions about their care (BMJ 1996; 312: 71-72).

Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare.”(Field, M.J., Lohr, K.N. 1992).

Nurses are also utilizing EBP. EBP stresses the use of protocols and procedures substantiated by research and evidence. EBP calls for nurses to continually question their practice and rely on the best available knowledge when providing quality care to their patients. Issues pertaining to the nurse’s liability will arise if EBP is not utilized.

The legal nurse consultant should review policies and procedures in effect at the time of an incident which caused harm to the patient. Standards of practice related to a particular nursing discipline should also be reviewed. •

Kathy Aldridge, MSN, ACM, CPHQ, CLNC is a certified legal nurse consultant with over 30 years of healthcare experience, klaldridge@bellsouth.net.