Question formulation using PICO

Asking the right question is a difficult skill to learn, yet it is fundamental to the evidence-based decision-making process.

This process almost always begins with a patient question or problem.

A "well-built" question should include four parts, referred to as PICO.

Formulate a question (PICO)

Translate clinical problem into a structured question and identify the key concepts – be specific.◦ Population (patient or problem)◦ Intervention◦ Comparison◦ Outcome

Formulate a question (PICO)

Define disease/condition Severity, stages of condition Setting (hospital, community) Age range, Gestation Other illnesses Exclusions?

Population (Problem or Patients)

Define intervention– Dose, duration, frequency, route– Drugs - any in a class?– Define optional and essential elements of the intervention – who, how, when?– how easy would these be to implement in clinical practice?

Interventions

Specify the comparison• Placebo• Nothing• Usual care• Other intervention –best evidenced based alternative

Comparison

• What outcomes are important, and to whom?

• Have scales or measurement tools been validated?

• Use of surrogate outcomes - related to the “real outcome”

• Primary vs. secondary

Outcome

Once you have identified a patient problem and defined your question using PICO, you are ready to find the most current valid evidence.

Purpose Statement: The purpose of this evidence based project is to determine the

perceptions of anesthesia providers regarding the use of a disposable laryngoscope blade, their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed to increase use of disposable blades.

PICO: In patients requiring intubation (P), how does the use of a

disposable laryngoscope blade (I) compared with a reusable laryngoscope blade (C) affect ease of use, complications, and cost (O)?

(P) Patient, Population, Problem- Patients requiring intubation (I) Intervention-Disposable Laryngoscope Blades (C) Comparison-Reusable Laryngoscope Blades (O) Outcome –Ease of use, complications, and cost

Example