Evidence-based practice is wonderful...sort of.

What should nurses do in caring for intubated patients to prevent ventilatorassociated pneumonia? What is the most effective way to suction patients who are ventilator dependent? Should patients experiencing acute coronary syndrome be given thrombolytics or just be whisked to the catheterization laboratory for a cardiac angiogram, angioplasty, and stent? Should all diabetic patients, regardless of their lipid levels, receive statin therapy? What is the best way to prevent wound infections in high-risk patients? Can pressure ulcers be prevented in comatose patients? The answers to all of these questions are known and well documented in the literature. Every day, clinicians—nurses, physicians, respiratory therapists, and others—confront difficult questions about caring for acutely ill patients. We want to know how to interpret a diagnostic test accurately, how to predict the prognosis of a specific patient, how to identify the comparative effectiveness of 2 therapeutic interventions, and how to compare the costs of our various options. Clinicians, the public, and policy makers all need to know the most effective care—from a clinical and cost perspective—for a patient hospitalized in an acute care setting. Increasingly, the answers to these questions are found in the guidelines that have evolved from systematic research.