| Course | EDN 820 Evidence-Based Practice and Quality Improvement |
|---|---|
| Module | Module 3 |
| Paper type | Evidence appraisal |
| Length | About 1,108 words, 7 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Doctor of Education |
| Updated | September 2026 |
Free sample paper for EDN 820 Module 3
Will It Work Here? Appraising the Evidence on Perioperative Warming for Its Fit With a Community Hospital
Student Name
Doctor of Education Program, Aspen University
EDN 820: Evidence-Based Practice and Quality Improvement
Instructor Name
Month Day, Year
Will It Work Here? Appraising the Evidence on Perioperative Warming for Its Fit With a Community Hospital
Module 2 identified three sources on preventing perioperative hypothermia: a randomized trial of short prewarming periods, a Cochrane review of active warming systems and a randomized trial linking normothermia to fewer wound infections. Finding evidence is not the same as knowing it applies. Allerton Community Hospital's surgical population, operating room flow and equipment differ from those of the study hospitals. This paper appraises each source for validity, results and applicability, judges the overall certainty of the evidence and decides whether it supports prewarming at Allerton.
An Appraisal Framework
Appraisal asks three questions of each study. Are the results valid, meaning was the study designed and conducted to minimize bias? What are the results, including their size and precision? And will the findings hold for the patients in front of me, meaning are the study's patients, interventions and settings close enough to mine? The third question, applicability, is the one the course emphasizes, and it is often neglected because it requires knowing one's own setting as well as the study.
The Prewarming Trial
Horn et al. (2012) randomized 200 adults scheduled for 30 to 90 minutes of surgery under general anesthesia to one of four groups: blankets only, or 10, 20 or 30 minutes of forced-air warming before induction. At the end of anesthesia, 38 of 55 patients who had not been prewarmed, 69%, were below 36 degrees Celsius, while the rates after 10, 20 and 30 minutes of prewarming were 13%, 7% and 6%. Shivering was also less common with prewarming. The trial was randomized and used a clear outcome, but it was small, measured temperature at the tympanic membrane, and studied relatively short operations at one center.
The Cochrane Review
Madrid et al. (2016) pooled 67 randomized trials with 5,438 participants comparing active body surface warming with control or with other warming methods; forced-air warming was the most studied. Active warming reduced surgical site infection, with a risk ratio of 0.36 from three trials and 589 participants, and reduced shivering, but the review rated much of the evidence as low quality because most trials were open-label and many had unclear risk of bias. It found no effect on mortality, and extending warming into the preoperative period showed benefit in one low-risk-of-bias study of major abdominal surgery.
The Foundational Wound Infection Trial
Kurz et al. (1996) randomly assigned 200 patients having colorectal surgery to routine thermal care or additional warming. Mean final intraoperative core temperature was 34.7 degrees in the routine group and 36.6 degrees in the warmed group; wound infections occurred in 19% and 6% respectively, and hospital stays were 2.6 days longer with hypothermia. The trial was double-blind for wound assessment and has shaped practice for decades, but it studied one type of surgery, used antibiotics of its era and predates many current practices.
Appraisal at a Glance
The table summarizes the appraisal.
| Source | Validity | Main result | Applicability to Allerton |
|---|---|---|---|
| Horn et al. (2012) randomized trial | Randomized; small; single center; tympanic temperature | Hypothermia 69% without prewarming vs 6% to 13% with it | High for short general anesthesia cases; Allerton's cases are often longer |
| Madrid et al. (2016) Cochrane review | Systematic; many trials of low or unclear quality | Fewer infections and less shivering with active warming | High for the general principle of active warming |
| Kurz et al. (1996) randomized trial | Randomized; blinded wound assessment | Wound infection 19% vs 6%; stay 2.6 days shorter | Moderate; colorectal surgery only, older practices |
Strength and Certainty
Taken together, the sources provide consistent evidence that active warming keeps patients warmer and reduces shivering, with moderate-certainty support for a lower infection rate and weaker support for other clinical outcomes. The specific evidence for prewarming comes mainly from smaller trials, of which Horn et al. is representative. The certainty is not high, but the intervention is low risk, inexpensive with equipment the hospital already owns, and aligned with patient comfort, which lowers the bar for adoption.
Differences That Matter
Several differences between the study settings and Allerton could change the effect. Allerton's cases include many longer orthopedic and abdominal operations, for which prewarming alone is less likely to prevent hypothermia without continued intraoperative warming. Patients arrive in a crowded preoperative holding area with four bays that are already busy, which may make 20 minutes of warming hard to achieve. Allerton measures temperature on arrival in recovery with temporal artery thermometers, which read differently from core or tympanic measurements. And many patients are older, a group in whom hypothermia is more common.
What Transfers and What Does Not
The mechanism transfers: prewarming reduces the early drop in core temperature under general anesthesia in any adult. How large the benefit will be is less certain: with longer cases and different thermometers, Allerton may not see reductions as dramatic as Horn's. Implementation certainly does not transfer automatically, since the studies did not face Allerton's holding area constraints. These judgments shape the improvement plan: prewarming should be combined with intraoperative warming, the holding area process must be redesigned to fit 20 minutes of warming, and results must be measured with Allerton's own thermometers.
Recommendation
The evidence supports warming eligible adults with forced air for a minimum of 20 minutes ahead of induction, for adults having general anesthesia expected to last 30 minutes or longer, combined with continued intraoperative active warming. Because applicability is uncertain in some respects, the practice should be introduced through a quality improvement project that measures temperature on arrival in recovery, the proportion of patients who actually receive 20 minutes of prewarming and any delays to operating room start times.
The Patient's Perspective
Evidence-based practice includes patients' values, not only research. Surgical patients often describe feeling cold before and after surgery as one of the most unpleasant parts of the experience, and shivering in recovery is distressing as well as uncomfortable. Warming also has a practical appeal for patients: it requires nothing of them beyond wearing a gown. The team will nonetheless ask patients about comfort during the project, since a few may find warming unpleasant, and any patient may decline it. Patient experience therefore supports adoption and will be tracked as a balancing concern.
Conclusion
Appraisal showed valid, consistent, if not high-certainty, evidence that active warming, including prewarming, prevents hypothermia and its harms. Applicability analysis showed that the principle transfers to Allerton but that the size of the effect and the practicality of implementation depend on local conditions: longer cases, a crowded holding area, different thermometers and an older population. The evidence therefore supports a change in practice introduced as an improvement project that tests it locally.
References
Horn, E.-P., Bein, B., Böhm, R., Steinfath, M., Sahili, N., & Höcker, J. (2012). The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia, 67(6), 612-617. https://doi.org/10.1111/j.1365-2044.2012.07073.x
Kurz, A., Sessler, D. I., & Lenhardt, R. (1996). Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine, 334(19), 1209-1216. https://doi.org/10.1056/NEJM199605093341901
Madrid, E., Urrútia, G., Roqué i Figuls, M., Pardo-Hernandez, H., Campos, J. M., Paniagua, P., Maestre, L., & Alonso-Coello, P. (2016). Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database of Systematic Reviews, (4), Article CD009016. https://doi.org/10.1002/14651858.CD009016.pub2
What the EDN 820 Module 3 instructions ask for
Assessing whether evidence-based practice applies to health care delivery is the first tool Aspen's EDN 820 description lists, and with the Module 3 prompt available through the class site, this example appraises a body of evidence for fit with one hospital. Expect to judge each source's validity, report its results with their size and precision, and then ask whether its patients, interventions and setting resemble yours. Give applicability as much space as validity, since it is the part most often skipped. Name the specific local conditions that could change the effect. Separate what should transfer, such as a biological mechanism, from what may not, such as the size of an effect or the way a study delivered the intervention. Finish with a recommendation that reflects the certainty you found.
Inside the EDN 820 Module 3 example
The paper recalls the three sources from Module 2 and sets out a three-question framework: validity, results and applicability. Each source then receives its own appraisal: the prewarming trial with hypothermia in 69% of unwarmed patients and 6% to 13% of warmed ones, the Cochrane review that found fewer infections and less shivering but rated much evidence as low quality, and the 1996 trial with wound infections of 19% and 6%. A four-column table summarizes validity, results and fit. Later sections judge overall certainty, list local differences such as longer cases and temporal artery thermometers, separate what transfers from what does not, bring in patients' views of feeling cold, and recommend prewarming combined with intraoperative warming, introduced as an improvement project.
Where the marks sit in the EDN 820 Module 3 rubric
Appraisal papers are marked on accurate critique, correct reporting of results, a genuine applicability analysis and a recommendation proportionate to certainty. This example reports each study's design, size and main numbers accurately and names specific weaknesses such as open-label trials and tympanic measurement. Its APA sources are the Horn prewarming trial, the Cochrane review of active warming systems and Kurz and colleagues' wound infection study. The applicability sections carry the paper, because they compare study conditions with the hospital's own case mix, space and thermometers rather than assuming results will travel. Recommending adoption through a measured improvement project, rather than a mandate, shows the proportion between evidence and action that instructors reward.
EDN 820 Module 3 help from the desk
A frequent weakness is an appraisal that summarizes studies without judging them, or that judges validity carefully and then declares the evidence applicable in one sentence. Spend real effort on fit: compare the study patients, interventions and settings with yours point by point. Use an appraisal tool your program recommends for each study type, and say which one. Report results with numbers, not only words like significant. Distinguish low certainty from no evidence. Include patient preferences, which are part of evidence-based practice. Let your recommendation follow from what you found, including uncertainty. If a Cochrane review's risk ratios and quality ratings are hard to read, a tutor can go through one table with you.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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EDN 820 Module 3 questions, answered
What does EDN 820 Module 3 usually ask for?
Aspen's EDN 820 gives students tools to assess the applicability of evidence-based practice to health care delivery, so appraising evidence for fit with a local setting is a typical third assignment. Follow your classroom prompt.
What does applicability mean in evidence appraisal?
Whether a study's patients, interventions and settings are similar enough to your own that its results are likely to hold in your practice.
Does prewarming prevent perioperative hypothermia?
In one randomized trial, 69% of patients without prewarming were hypothermic at the end of anesthesia, compared with 6% to 13% of patients prewarmed for 10 to 30 minutes.
Where can I find a free EDN 820 Module 3 sample paper?
Read it in full above: an appraisal of three sources on perioperative warming, with a four-column table of validity, results and applicability to a community hospital.
What is the difference between validity and applicability?
Validity asks whether a study's results are trustworthy; applicability asks whether those results are likely to hold for your own patients and setting.