Using Evidence to Improve Care

Abstract

Evidence-based care uses the best research and individual expertise to make decisions with patients. Although much of the focus to date has been on generating evidence from high-quality research such as randomized clinical trials (RCTs)1, the next critical step is to ensure that the evidence is applied to the care of patients. This article used an evidence-based practice guideline and a multidisciplinary team to improve the care of children with osteomyelitis. Osteomyelitis is a relatively common pediatric orthopaedic issue that has become increasingly problematic because of the emergence of virulent and treatment-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). Osteomyelitis can be classified as complicated or uncomplicated. Uncomplicated osteomyelitis typically has a short duration of symptoms, minimal local clinical signs, and no radiographic changes, and responds rapidly to antibiotics. Complicated osteomyelitis presents late or has a short, rapidly progressive course, with local signs of an abscess, systemic signs of infection, extensive soft-tissue involvement, and radiographic changes, and usually requires operative intervention with prolonged antibiotic therapy. Failure to adequately treat osteomyelitis not only leads to prolonged hospitalization, but also may result in permanent disability and/or chronic infection. As evidenced by the experience of the …