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Quality Improvement Reports

Integrating evidence based medicine into routine clinical practice: seven years' experience at the Hospital for Tropical Diseases, London

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1020
  1. Diana Lockwood, consultant physician1,
  2. Margaret Armstrong, research coordinator1,
  3. Alison Grant, consultant physician (alison.grant{at}
  1. 1 Hospital for Tropical Diseases, University College London Hospitals NHS Trust, Mortimer Market Centre, London WC1E 6AU
  1. Correspondence to: A Grant
  • Accepted 4 August 2004


Problem Introduction and evaluation of evidence based medicine (EBM) into routine hospital practice.

Strategy for change Routine EBM meetings introduced in 1997.

Design Review of outcomes of meetings from 1997 to 2004, focusing on their effect on clinical practice.

Setting Referral centre for tropical and domestic infectious diseases.

Key measure for improvement Outcome of meetings, classified as resulting in a change in practice; confirmation or clarification of existing practice; identification of a need for more evidence; and outcome unclear.

Effects of change Examples include a change from inpatient to day case treatment of New World cutaneous leishmaniasis; development of guidelines on the treatment of coinfection with visceral leishmaniasis and HIV; and identification of the need for more data on the efficacy and toxicity of atovaquone-proguanil (Malarone) compared with quinine plus sulfadoxine-pyrimethamine (Fansidar) in the treatment of uncomplicated falciparum malaria, which resulted in a clinical trial being set up.

Lessons learnt Incorporation of EBM meetings into our routine practice has resulted in treatment guidelines being more closely based on published evidence and improvements to care of patients. Written summaries of the meetings are important to facilitate change.


  • Embedded Image See for details of notes given to chair of meeting

  • Contributors DNJL established and has overseen the EBM sessions since 1997. MA manages the EBM database. ADG had the idea for the article, which was further developed by DNJL and MA. ADG and DL wrote the paper. All authors approved the final paper. ADG is guarantor.

  • Funding MA is supported by the Special Trustees of the Hospital for Tropical Diseases. ADG is supported by a National Public Health Career Scientist award from the Department of Health.

  • Competing interests None declared.

  • Ethical approval Not required.

  • Accepted 4 August 2004
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