If the evidence-based practice movement is to successfully improve patient outcomes, then we must develop a better understanding of what the phrase “best available evidence” implies. In July’s editorial, “All ICUs Are Not Created Equal: Evaluating Pilot Studies Performed in Different Environments,”1 the editors missed an opportunity to inform readers of the larger issue of the appropriateness of directly implementing findings from single studies.

Single studies may be the best available evidence, but rarely provide a definitive answer about the effectiveness of an intervention. I was discouraged when the editors implied that any single study, regardless of design, setting, or scope, might be ready for “transferring into” a clinical facility.

Authors of the recent Institute of Medicine report, Knowing What Works in Health Care: A Roadmap for the Nation, stated: “There cannot be a single study that covers all populations, intervention...

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