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 hospital in this report, the treatment of osteomyelitis is variable among individuals, institutions, and regions. Thus, the application of best evidence has the potential to have a significant impact on outcome for children with osteomyelitis.

    Clinicians can easily be overwhelmed by the amount of clinical evidence. Furthermore, clinicians may not have the time or expertise to critically appraise and to identify the best evidence. Practice guidelines are one strategy to provide evidence in a usable format for clinicians. Although elements of effective guidelines are beyond the scope of this commentary and require formal methods of appraisal as a key such as the Appraisal of Guidelines for Research and Evaluation (AGREE) or Grading of Recommendations Assessment, Development and Evaluation (GRADE), they include a focus on a high quality of evidence, a systematic approach to identifying and appraising the evidence, and the involvement of a multidisciplinary and expert group with broad input into the final product. However, even with appropriate guidelines, sometimes the challenge is changing physician behavior.

     The four steps in implementing guidelines are awareness, agreement, adoption, and adherence2. All of these steps require attention and, although they are also beyond the scope of this commentary, generally require multiple strategies for implementation3.