Background: Grading evidence using hierarchical systems have been around since the 1990’s. The evidence pyramid was first developed as a useful aid to identify high quality evidence. The purpose of this talk is to describe an alternative to the evidence pyramid, which is a simple to use but incomplete method for determining the best evidence for practice. Another aim of this talk is to stimulate conversation with colleagues to obtain input and ideas for further consideration.
Description: Following discussion with two nurse specialists in evidence-based practice from an affiliated teaching hospital, a literature search was conducted to further examine the problem. One concern is that the pyramid has been used incorrectly at times, especially for questions that are not intervention/therapy focused, which may lead a clinician to not notice or to disregard evidence that may in fact be significant. Another issue is that the pyramid does not incorporate patient (or health system) values, which is an essential element of evidence-based practice. Several other concerns with the pyramid will be detailed. An evidence funnel model will be presented as a supplement or alternative to the evidence pyramid.
Conclusion: Turning the evidence pyramid upside down creates the evidence funnel as an innovative solution for sifting through evidence. However, as use of the pyramid has been widely adopted in many health sciences specialties, introducing a different approach is challenging. The education and dissemination of this approach in process at this institution will be described.