Exposure to surgical smoke (SS) in the operating room (OR) is an occupational hazard and may harm patients. Smoke evacuation devices (SEDs) are available, but not uniformly utilized, at Doernbecher Children?s Hospital (DCH). By assessing and describing the current state of SED use at DCH, a comprehensive understanding of its underutilization may allow for future local interventions that more effectively and consistently protect patients and staff from the hazards of SS. This quality improvement (QI) project evaluated OR personnel?s adoption or rejection of SEDs through survey questions informed by Roger?s Diffusion of Innovation (DOI) theory. Survey methodology, targeted interviews, and record review were employed to describe the current state of SED use and identify perceived benefits and barriers to their use in DCH ORs. Report data revealed only 3.2% of annual SS-generating cases at DCH utilized SEDs. Survey and targeted interview data highlighted opposing views regarding their use. Perceived benefits of SED use include patient and OR personnel safety and perceived barriers include inconvenience or interference with the procedure (including bulkiness of the device), impaired surgical field visualization, and surgeon preference. OR personnel across specialties indicated a need for mandatory institutional policy, legislative change, or a significant change in the culture surrounding SED use at DCH. Future work should focus on standardizing education regarding the hazards of SS to all DCH OR personnel and improving communication surrounding this topic among staff members.