1. 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

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

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

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

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

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

7.  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.

8.  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

9.  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

10.  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

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

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

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

14.  National Guideline Clearinghouse ◦ www.ngc.gov  The Cochrane Library ◦ www.chchrane.de  Evidence Based Journals ◦ e.g. www.evidencebasednursing.com  Professional Organization Guidelines  PubMed ◦ www.ncbi.nlm.nih.gov/PubMed

15.  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?

16.  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

17.  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

18.  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?