Do we practice evidence-based care in our neonatal intensive care units?

The RPA NICU has attempted to work as a team to provide consistent family centered care based on the best available evidence. This has been facilitated by a number of factors. The RPA NICU is in an academic institution with most staff involved in teaching and research and clinical care. All of the consultant neonatologists have research degrees, a factor associated with the use of evidence in practice. A key factor is the collaborative effort among consultant neonatologists with an agreement that consistent care is important. Staff buy-in is important for consistent approaches to care 24 hours a day at every bedside when there are rotating house staff and nurses. A team effort involving both physicians and nurses is particularly important in this regard. Difficulties do arise when there is insufficient evidence to inform practice in acute care settings. When treating seriously ill newborns, pressure from anxious staff and parents to "do something" is great. It is tempting to introduce new high-technology treatments, such as high-frequency oscillatory ventilation or extracorporeal membrane oxygenation, before their usefulness has been established. In these situations, a clear distinction is required between practice and research. Where possible, new treatments should be evaluated within a scientific framework so as to add new knowledge about the clinical intervention. It is difficult (although not necessarily impossible) to discontinue a practice that has been in routine use despite a lack of evidence. Management of hyperbilirubinemia in term and preterm infants is a good example. Replacing competition with collaboration and consensus among staff and agreeing to a broad framework for systematic evaluation, implementation, and evaluation of evidence in patient-centered care should allow the authors' center and others to improve patient outcomes in the short term and promote better clinical research to improve outcomes in the future.