Evidence-Based Practice of Neurosurgery: Implications for Quality and Safety

Introduction

The fundamental assumption of evidence-based practice is that basing decisions in practice on best available evidence will maximize the likelihood of correct diagnosis, effective treatment, and minimal complications. Therefore, evidence-based practice should result in high quality, safe neurosurgical practice. It is therefore sensible to review the evidence-based practice of neurosurgery as a way to support efforts to improve quality and safety in neurosurgical practice. In this brief chapter, we will review the principles of evidence-based practice in neurosurgery and the role that formal quality and safety efforts play in continuously improving the evidence-based practice of neurosurgery.

Definitions

It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts. Sherlock Holmes, a Scandal in Bohemia

The definition of evidence-based neurosurgery with which we have worked since 2006 is “a paradigm of practicing neurosurgery in which:

• (a)

  the best available evidence is consistently consulted first to establish principles of diagnosis and treatment that are,

• (b)

  artfully applied in light of the neurosurgeons' training and experience informed by the patient's individual circumstances and preferences,

• (c)

  to regularly produce the best possible health outcomes.”

Encapsulated in this definition is that the evidence-based practitioner begins with generalizable knowledge about the condition to be treated, interprets that knowledge in light of the individual circumstances of the patient being treated, and is consistent in the application of these principles. The definition also recognizes that generalizable evidence cannot answer every question or deal with every individual circumstance the practitioner may confront and therefore allows for the artful application of principles to individual circumstances.