Evidence-Based Practice Committee Research Articles

Evaluation and Management of Primary Spontaneous Pneumothorax in Adolescents and Young Adults: A Systematic Review From the APSA Outcomes & Evidence-Based Practice Committee

Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations. Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24-48h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment. The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention. Level 4. Systematic Review of Level 1-4 studies.

Poster 121: Inter- and Intra-Observer Agreement are Unsatisfactory when Determining Study Design and Level of Evidence

Objectives:Understanding differences between types of study design (SD) and level of evidence (LOE) are important when selecting research for presentation or publication and determining its potential clinical impact. The purpose of this study was to evaluate inter- and intra-observer reliability when assigning LOE and SD as well as quantify the impact of a commonly used reference aid on these assessments.Methods:Thirty-six accepted abstracts from the Pediatric Orthopaedic Society of North America (POSNA) 2021 annual meeting were selected for this study. Thirteen reviewers from the POSNA Evidence Based Practice Committee were asked to determine LOE and SD for each abstract, first without any assistance or resources. Four weeks later, abstracts were reviewed again with the guidance of the Journal of Bone and Joint Surgery (JBJS) LOE chart, which is adapted from the Oxford Centre for Evidence-Based Medicine. Inter- and intra-observer reliability were calculated using Fleiss’ kappa statistic (k). Chi-square analysis was used to compare the rate of SD-LOE mismatch between the first and second round of reviews.Results:Inter-observer reliability for LOE improved slightly from fair (k=0.28) to moderate (k=0.43) with use of the JBJS chart. There was better agreement with increasing LOE, with the most frequent disagreement between levels 3 and 4. Inter-observer reliability for SD was fair for both rounds 1 (k=0.29) and 2 (k=0.37). Similar to LOE, there was better agreement with stronger study design. The most common disagreements were between retrospective cohort, retrospective case-control, and case series. Intra-observer reliability was widely variable for both LOE and SD (k=0.10 to 0.92 for both). When matching a selected SD to its associated LOE, the overall rate of correct concordance was 82% in round 1 and 92% in round 2 (p<0.001). Six of the 13 respondents improved in round 2, and 3 were 100% correct both times.Conclusions:Inter-observer reliability for LOE and SD was fair to moderate at best, even among experienced reviewers. Use of the JBJS/Oxford chart mildly improved agreement on LOE and resulted in less SD-LOE mismatch, but did not affect agreement on SD. Professional societies and journals may consider requiring more specific information on SD from authors, while authors and reviewers may benefit from improved instruments to guide SD and LOE designation.

Interobserver and Intraobserver Agreement are Unsatisfactory When Determining Abstract Study Design and Level of Evidence.

Understanding differences between types of study design (SD) and level of evidence (LOE) are important when selecting research for presentation or publication and determining its potential clinical impact. The purpose of this study was to evaluate interobserver and intraobserver reliability when assigning LOE and SD as well as quantify the impact of a commonly used reference aid on these assessments. Thirty-six accepted abstracts from the Pediatric Orthopaedic Society of North America (POSNA) 2021 annual meeting were selected for this study. Thirteen reviewers from the POSNA Evidence-Based Practice Committee were asked to determine LOE and SD for each abstract, first without any assistance or resources. Four weeks later, abstracts were reviewed again with the guidance of the Journal of Bone and Joint Surgery (JBJS) LOE chart, which is adapted from the Oxford Centre for Evidence-Based Medicine. Interobserver and intraobserver reliability were calculated using Fleiss' kappa statistic (k). χ2 analysis was used to compare the rate of SD-LOE mismatch between the first and second round of reviews. Interobserver reliability for LOE improved slightly from fair (k=0.28) to moderate (k=0.43) with use of the JBJS chart. There was better agreement with increasing LOE, with the most frequent disagreement between levels 3 and 4. Interobserver reliability for SD was fair for both rounds 1 (k=0.29) and 2 (k=0.37). Similar to LOE, there was better agreement with stronger SD. Intraobserver reliability was widely variable for both LOE and SD (k=0.10 to 0.92 for both). When matching a selected SD to its associated LOE, the overall rate of correct concordance was 82% in round 1 and 92% in round 2 (P<0.001). Interobserver reliability for LOE and SD was fair to moderate at best, even among experienced reviewers. Use of the JBJS/Oxford chart mildly improved agreement on LOE and resulted in less SD-LOE mismatch, but did not affect agreement on SD. Level II.

Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review

PurposeManagement of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. MethodsA comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. ResultsA total of 825 articles were identified in the initial search, and 260 were included in the final review. ConclusionsPre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.

Report on the Evidence-Based Practice Committee’s Survey on Dupuytren Disease

PurposeThe Evidence-Based Practice Committee of the American Society for Surgery of the Hand (ASSH) set out to assess the membership’s practice patterns (PPs) and knowledge of evidence-based principles for Dupuytren disease (DD).MethodsA 21-item multiple-choice survey was distributed to all ASSH members via email in June 2020. Questions were divided into 2 types: evidence-based practice (EBP) and PPs. The survey addressed the following subtopics: nonsurgical, percutaneous, and open surgical management of DD.ResultsThe response rate was 18% (n = 419). Of 13 EBP questions, 5 were answered with the preferred response by >75% of surgeons. The remaining 8 EBP questions had greater frequencies of less preferred responses, which concerned the current evidence for percutaneous management, as well as nonsurgical and postoperative management of DD. Of the PP questions, there were differences in opinion on how to manage a painful nodule, the percutaneous technique (eg, collagenase injection vs percutaneous needle aponeurotomy), and the choice of surgical incision for open fasciectomy (eg, Bruner incision with Z-plasties, partial closure with an open transverse palmar component, or longitudinal incision with Z-plasties).ConclusionsHand surgeons continue to be well informed about current evidence-based practices for treating DD and can improve their knowledge by familiarizing themselves with current data on percutaneous and nonsurgical methods. There exist differences in PPs for DD in the ASSH membership, specifically with less invasive management; and knowledge of peer practices can help navigate differences, critically interpret the evidence, and optimize patient care.Type of study/level of evidenceEconomic/Decision Analyses V.

Perceptions of Regional Anesthesia for Pediatric Supracondylar humerus fractures – a multispecialty survey

Background The purpose of this study was to compare the prior experiences, perceived risks, benefits, complications, and practice patterns in the use of regional anesthesia for pediatric supracondylar humerus fractures between orthopaedic surgeons and anesthesiologists to better understand the attitudes and experiences governing perioperative pain management in the opioid crisis. Methods An online survey consisting of 22 multiple-choice questions regarding usage of regional anesthesia for perioperative pain management of supracondylar humerus fractures was approved by the Evidence-based Practice committee of the Pediatric Orthopaedic Society of North America (POSNA) and distributed to the active members. The same survey was also distributed to anesthesiologists associated with pediatric anesthesiology teaching centers between January 2019-June 2019. The results were captured anonymously using a RedCAP database, after which the data was exported for analysis. Results Two hundred and seventy nine physicians participated in this survey (n=249 orthopaedic surgeons [89.2%]; n=30 anesthesiologists [10.8%]). In total, 162/279 (58.1%) reported at least 10 years of practice, 236/279 (84.6%) reported practicing in an academic setting, and 185/279 (66.3%) reported a minimum volume of 20 applicable cases per year. 69.9% of Orthopaedic surgeons were moderately or highly concerned regional anesthesia would mask a compartment syndrome compared to only 10% of anesthesiologist sharing that same level of concern (p&lt;0.001), although similar numbers of respondents treated patients with volkman’s contracture after a supracondylar humerus fracture. 76.1% of orthopaedic surgeons did not believe the level of perioperative pain warranted regional anesthesia compared to only 6.7% of anesthesiologists (p=0.005). Conclusion This multidisciplinary survey highlights the distinct differences in perceptions of regional anesthesia for supracondylar humerus fractures. These perceptional differences frame our opinions and willingness to changes our practices. This survey suggests perceptions on pain, risks, and benefits of regional anesthesia vary greatly between two major stakeholders treating the same injury.

Use of Telemedicine in Pediatric Orthopaedics Prior to the Pandemic: A Survey of POSNA Members.

Telemedicine, or telehealth, is broadly defined as the use of technology to deliver health care or health education at distance. Synchronous communication telemedicine, which involves the use of real time audio and video between patient and provider, is a developing field and its use in the pediatric orthopaedic population is not well defined. To better understand the existing use of and challenges posed by telemedicine for pediatric orthopaedic providers, the Pediatric Orthopaedic Society of North America (POSNA) practice management committee conducted a survey of current POSNA members. A 33-question survey was created by the POSNA Practice Management Committee, piloted among committee members and approved by the POSNA Evidence Based Practice Committee. A total of 167 responses were complete (75% complete response rate). Telemedicine use questions referred to the use of synchronous communication telemedicine. A total of 50% reported being "moderately" or "not really" familiar with telemedicine. Sixty percent of study participants reported their hospital systems utilize telemedicine; however, only 40% reported utilizing telemedicine in their own practice. Sixty-seven percent indicated interest in telemedicine training. Telemedicine was utilized for a variety of patient pathology and visit types 57% of study participants did not bill for telemedicine services. Sixty-three percent were unaware of their states' billing rules regarding telemedicine. The survey is an attempt to understand the current landscape of telemedicine use within pediatric orthopaedics. Currently, a minority of survey participants utilize synchronous communication telemedicine. There is a desire for telemedicine training and best billing practices education. Further study to evaluate the limitations and efficacy of telemedicine in the pediatric orthopaedic population will be necessary as its use increases.

Umbilical access in laparoscopic surgery in infants less than 3 months of age: A survey of the American Pediatric Surgical Association

PurposeLaparoscopy is commonplace in pediatric surgery. Abdominal access via the umbilicus may present a unique challenge in neonates and young infants predisposing them to complications.We hypothesized that these complications may occur more than described in the literature. MethodsMembers of the American Pediatric Surgical Association (APSA) were anonymously surveyed in February of 2018 via REDCap™ regarding technique of umbilical access in infants less than 3 months of age and complications experienced during umbilical access. Approval was obtained from the IRB and the APSA Outcomes and Evidence-based Practice Committee. ResultsThe response rate was 31.3% (329/1050). 62.3% of respondents performed 21 or greater neonatal laparoscopic procedures annually. 34 of 322 respondents reported a direct complication from umbilical access for laparoscopy in this age group (10.6%). Surgeons described 37 specific cases with complications related to umbilical access, with laparoscopic pyloromyotomy making up 47.2% (17/36). CO2 embolism was the most common complication; 15.4% of surgeons reported not knowing about the possibility of CO2 embolism. 41% of surgeons confirm intraabdominal placement of the umbilical trocar prior to insufflation. There was no association between any complication and where the umbilical trocar was placed (above/below/through umbilicus) or placement technique in patients with no umbilical cord stump. There may be an association between complication and where the umbilicus is entered in patients with an umbilical cord stump still in place (p = 0.013). ConclusionsUmbilical access for laparoscopy in neonates and infants less than 3 months of age can present a unique challenge and result in significant complications. All techniques and methods had complications. Surgeons should be aware of these risks and be prepared to manage them emergently if they arise. Level of evidenceV, expert opinion.

Advanced providers in pediatric surgery: Evaluation of role and perceived impact

IntroductionThe shortage of medical doctors in certain geographies and certain disciplines, resident work hour limitations and the demonstrated positive impact of advanced providers (nurse practitioners, physician assistants and clinical nurse specialists) on the quality and efficiency of care in numerous specialties have led to broader integration of advanced providers in healthcare organizations. With regard to pediatric surgery, some tertiary centers have successfully implemented 24/7 nurse practitioner coverage for their inpatient services. However, pediatric surgery practices vary throughout North America and the broader presence and function of advanced providers among all practice types and settings has not been characterized previously. The purpose of this survey is to conduct a descriptive evaluation of current pediatric surgical practices in North America with regard to advanced provider coverage and their perceived impact on care delivery and patient satisfaction. MethodsA 14-item online survey, approved by the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee, was distributed to all full APSA members (N = 1189, opening rate of 56%), representing the vast majority of pediatric surgeons in North America. The survey investigated the practice characteristics of the responding surgeon, the presence and role of advanced providers in their practice and their perceived impact on patient care. Descriptive statistics were performed to characterize the function of advanced providers in pediatric surgery practices. Further analysis was performed to assess for geographic differences in staffing practices using United States Census Divisions. ResultsA total of 266 pediatric surgeons completed the survey (response rate 22% and 40% considering “email send out” and “email opening” rates respectively), with 47.6% employed at free standing children's hospitals and 41.1% employed at a children's hospital within an adult hospital. Nearly all respondents (N = 244, 91.7%) reported the presence of advanced providers in their practice with nurse practitioners (N = 216) and physician assistants (N = 101) most commonly represented. The majority of advanced providers (N = 189, 77.8%) covered both general surgery and trauma patients. Advanced providers worked nearly equally in the outpatient (N = 219, 89.8%) and inpatient setting (N = 232, 95.1%), though less often in the neonatal (N = 131) or pediatric (N = 126) intensive care unit. Fifteen percent of surgeons (N = 40) reported that advanced providers provided 24/7 coverage within their surgical practice. Surgeons reported that advanced providers had a very positive (75%) or positive (21%) impact on their clinical practice, with none reporting a negative impact. Surgeons also reported that advanced providers had a very positive (74%) or positive (21%) impact on perceived patient satisfaction. The main area in which surgeons reported the most significant impact of associate providers was continuity of care (N = 77), efficiency of service (N = 66) and education of parents and patients (N = 53). ConclusionPediatric surgical practices of all types are broadly utilizing advanced providers. Surgeons report that the integration of advanced providers across inpatient and outpatient settings has positively impacted care, advancing both continuity of care and efficiency of service.Advanced providers likely represent part of the solution to delivering quality care in current delivery systems. Study TypeProspective Study/ Survey Level of EvidenceIV

Evidence-based Medicine in Pediatric Orthopaedics: Evidence-based Practice Committee Summary of Levels of Evidence, Clinical Practice Guidelines, Appropriate Use Criteria, and Best Practice Guidelines.

The concept of evidence-based medicine has evolved over the past 2 decades, and has become a cornerstone to clinical decision-making in virtually every aspect of medicine. With a commitment to providing its members with high-quality evidence-based guidelines, the American Academy of Orthopaedic Surgeons has instituted concerted efforts since 2006 to develop clinical practice guidelines (CPGs) and appropriate use criteria (AUCs) for certain orthopaedic conditions. Many of these CPGs and AUCs detail the management of pediatric orthopaedic conditions. By the same token, members of the Pediatric Orthopaedic Society of North America (POSNA) Evidence Based Practice Committee have been publishing succinct evaluations of randomized controlled trials in pediatric orthopaedic surgery to create an evidence-based repository for quick reference to available high-level evidence as well as resource to identify gaps in the current research and identify opportunities for future investigation. In instances where higher-level evidence needed to develop CPGs is not available to address a critically important clinical question, consensus recommendations from experts in the field have been obtained to develop best practice guidelines (BPGs). The purpose of this review is to provide readers with a deeper understanding of the key principles of evidence-based medicine and methodologies used for the development of CPGs, AUCs, and BPGs.

Time to appendectomy for acute appendicitis: A systematic review.

The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction. The committee selected three questions that were addressed by searching MEDLINE, Embase, and the Cochrane Library databases for English language articles published between January 1, 1970 and November 3, 2016. Consensus recommendations for each question were made based on the best available evidence for both children and adults. Based on level 3-4 evidence, appendectomy performed within 24h of admission in patients with acute appendicitis does not appear to be associated with increased perforation rates or other adverse events. Based on level 4 evidence, time from admission to appendectomy within 24h does not increase hospital cost or length of stay (LOS). Data are currently limited to determine an association between the timing of appendectomy and parent/patient satisfaction. There is a paucity of high-quality evidence in the literature regarding timing of appendectomy for patients with acute appendicitis and its association with adverse events or resource utilization. Based on available evidence, appendectomy performed within the first 24h from presentation is not associated with an increased risk of perforation or adverse outcomes. Systematic Review of Level 1-4 studies.

Ovarian torsion in pediatric and adolescent patients: A systematic review

ObjectiveOvarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide recommendations regarding the optimal treatment of ovarian torsion. MethodsUsing PRISMA guidelines, six questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Risks of ovarian detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of detorsion including recovery of function and subsequent fertility, and recommended surveillance after detorsion were evaluated. Consensus recommendations were derived for each question based on the best available evidence. ResultsNinety-six studies were included. Risks of ovarian detorsion such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary does not correlate with long-term ovarian viability or function. Pregnancies have occurred in patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion is an ultrasound at 3months postprocedure but sooner if there is a concern for malignancy. ConclusionThere appears to be overwhelming evidence supporting ovarian detorsion rather than oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after detorsion. Type of studySystematic review of level 3–4 studies. Level of evidence3–4

Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee.

Variation in management characterizes treatment of infants with a congenital pulmonary airway malformation (CPAM). This review addresses six clinically applicable questions using available evidence to provide recommendations for the treatment of these patients. Questions regarding the management of a pediatric patient with a CPAM were generated. English language articles published between 1960 and 2014 were compiled after searching Medline and OvidSP. The articles were divided by subject area and by the question asked, then reviewed and included if they specifically addressed the proposed question. 1040 articles were identified on initial search. After screening abstracts per eligibility criteria, 130 articles were used to answer the proposed questions. Based on the available literature, resection of an asymptomatic CPAM is controversial, and when performed is usually completed within the first six months of life. Lobectomy remains the standard resection method for CPAM, and can be performed thoracoscopically or via thoracotomy. There is no consensus regarding a monitoring protocol for observing asymptomatic lesions, although at least one chest computerized tomogram (CT) should be performed postnatally for lesion characterization. An antenatally identified CPAM can be evaluated with MRI if fetal intervention is being considered, but is not required for the fetus with a lesion not at risk for hydrops. Prenatal consultation should be offered for infants with CPAM and encouraged for those infants in whom characteristics indicate risk of hydrops. Very few articles provided definitive recommendations for care of the patient with a CPAM and none reported Level I or II evidence. Based on available information, CPAMs are usually resected early in life if at all. A prenatally diagnosed congenital lung lesion should be evaluated postnatally with CT, and prenatal counseling should be undertaken in patients at risk for hydrops.

Academy Approves NIAID Addendum Guidelines for the Prevention of Peanut Allergy

Academy Approves NIAID Addendum Guidelines for the Prevention of Peanut Allergy

Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review

ObjectiveThe goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the surgical treatment of pediatric gastroesophageal reflux disease (GERD). MethodsFive questions were addressed by searching the MEDLINE, Cochrane, Embase, Central, and National Guideline Clearinghouse databases using relevant search terms. Consensus recommendations were derived for each question based on the best available evidence. ResultsThere was insufficient evidence to formulate recommendations for all questions. Fundoplication does not affect the rate of hospitalization for aspiration pneumonia, apnea, or reflux-related symptoms. Fundoplication is effective in reducing all parameters of esophageal acid exposure without altering esophageal motility. Laparoscopic fundoplication may be comparable to open fundoplication with regard to short-term clinical outcomes. Partial fundoplication and complete fundoplication are comparable in effectiveness for subjective control of GERD. Fundoplication may benefit GERD patients with asthma, but may not improve outcomes in patients with neurologic impairment or esophageal atresia. Overall GERD recurrence rates are likely below 20%. ConclusionsHigh-quality evidence is lacking regarding the surgical management of GERD in the pediatric population. Definitive conclusions regarding the effectiveness of fundoplication are limited by patient heterogeneity and lack of a standardized outcomes reporting framework. Type of studySystematic review of level 1–4 studies. Level of evidenceLevel 1–4 (mainly level 3–4)

Implementation of an Evidence Based Practice Committee in the Peri-Anesthesia Care Unit

Evidence based practice is no longer recognized as an “above the standard” performance of a nurse, but instead a baseline competence. However, a lack of skills in evaluating research findings is one of the barriers to nurses utilizing this information in the clinical area and their participation in research studies (Polit & Beck, 2010, p.39).

Infant Pain Assessment: A Quality Improvement Project in a Level III Neonatal Intensive Care Unit in Northeast Florida

Pain assessment is the cornerstone of pain management. This article discusses the quality improvement project of the neonatal intensive care unit (NICU) interdisciplinary Evidence-Based Practice Committee of a level III NICU in Northeast Florida whose goal was to determine best practice for pain assessment. The problem addressed in this project was to determine if the current pain assessment tool used in the NICU was the most appropriate choice for the patient population. Six Sigma methodologies were used as the framework to guide the project. The project included a comparison study regarding the clinical utility of two infant pain assessment tools: the Premature Infant Pain Profile and the Neonatal, Pain, Agitation, and Sedation Scale. The results showed no statistically significant difference. The recommendation of the Neonatal, Pain, Agitation, and Sedation Scale as best practice infant pain assessment tool was based on its comprehensiveness in infant assessment and not on clinical utility.

Forming and Supporting A Divisional Evidence Based Practice Committee

Forming and Supporting A Divisional Evidence Based Practice Committee

Cultivating Quality: Implementing Surgical Smoke Evacuation in the Operating Room

Inspired by a presentation at an educational conference, two operating room (OR) nurses at Children's Hospital Boston raised concerns at the hospital's perioperative evidence-based practice committee meeting about the potential hazards associated with exposure to surgical smoke and aerosols. The nurses initiated a safety project involving the use of smoke evacuation devices in ORs. The subsequent policy development took two years and involved a literature review, a survey of other institutions, and the support of numerous stakeholders. A utilization review and supportive educational initiatives are ongoing.

Evidence Based Practice Committee

Purpose: Mindful of the importance of assuring projects for process improvement are formatted with evidence based practice guidelines. Our PACU (perianesthesia recovery room) developed our own unit-based “Evidence Based Practice (EBP) Committee” to monitor projects and provide consistency in their progress.