Christopher Manacci, MSN, ACNP, CCRN Acute Care Nurse Practitioner Critical Care Transport Services The Cleveland Clinic Director, ACNP Flight Nursing Program The National Flight Nurse Academy Case Western Reserve University

 Define EBP  Discuss the process for developing EBP  Identify levels of evidence  Discuss how to evaluate evidence  List strategies for making EBP changes

 Integration of best research evidence with clinical expertise and patient values ◦ Identify a clinical problem ◦ Asking an answerable question ◦ Searching for evidence ◦ Evaluating evidence

 Clinical practice – high volume, high cost patient populations  Quality assurance indicators  Regulatory requirements, accreditation standards

Strong questions have 4 components: Problem of interest Main intervention Comparison intervention, if relevant Outcome of interest

Searching for evidence  Start with Systematic Reviews  Clinical trials  Experimental studies  Quasi experimental studies  Descriptive or Qualitative  Case Studies

 Systematic review is a summary of research literature that uses explicit methods to systematically search, critically appraise, and synthesize the literature on a specific issue. ◦ Meta-analysis – a type of systematic review that uses quantitative methods to summarize the results.

 Clinical Trial: ◦ random assignment of subjects ◦ double blinded ◦ prospective ◦ one or more interventions are tested in an experimental group and compared to a control group

 Experimental study has: ◦ Random assignment of subjects to an experimental and control group ◦ An independent variable that the investigator manipulates (intervention) ◦ A dependent (outcome) variable

 Quasi-experimental has: ◦ No Random assignment of subjects to an experimental and control group ◦ An independent variable that the investigator manipulates (intervention) ◦ A dependent (outcome) variable

 Descriptive, Correlational, Survey: ◦ Main objective is to understand the characteristics of persons, situations, or groups; and/or the frequency with which certain phenomena occur.

 Qualitative: ◦ Main objective is to describe a phenomenon or understand an experience ◦ Data is collected in narrative (nonnumeric) form

 Case Study: ◦ An in-depth analysis of an individual, group, institution or other social unit

 National Guideline Clearinghouse ◦  The Cochrane Library ◦  Evidence Based Journals ◦ e.g.  Professional Organization Guidelines  PubMed ◦

 Systematic Reviews (SR):  Are the results of the SR valid?  Are the results important?  Can you apply this evidence in caring for your patients?  What is the clinical bottom line?

 The Association of Air Medical Services Research Committee developed several surveys  Identify the restraining forces related to the lack of research  Identify the priorities in air medical research  Develop a cohort of member programs to create, encourage and promote research

 Auto Launch  Early Activation  Appropriate use of air medical services  Criteria for waiting on scene for air medical services  Relationship of number and type of missions and patient outcomes  Is there a difference in outcome utilizing different team configurations, e.g. Advanced Practice v. Traditional

 What is auto launch and do we all define it the same way?  Is auto launch different than early activation?  Is auto launch cost effective?  Does auto launch improve outcomes in the trauma population?