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Dr. Ravi Patel, Professor at Emory University and Chair of the Georgia Perinatal Quality Collaborative, examines the tension between quality improvement and evidence-based medicine. He argues NICUs should prioritize high-certainty interventions (antenatal steroids, delayed cord clamping) rather than standardizing practices based on low-certainty evidence. Using tools like GRADE to assess evidence certainty helps determine when standardization is appropriate versus when practice variation allows for shared decision-making. Patel advocates re-energizing evidence generation as improvement in common morbidities has stalled. Examples like Eat Sleep Console demonstrate the value of prospective evaluation when adopting new practices. When evidence is uncertain, integrating family values and preferences becomes essential for individualized care decisions.

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