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Effect of a Computerized Reminder on Splinting of Pediatric Upper Limb Fractures in the Emergency Department
Erin Mills1, Simon Craig, Ed Oakley
1From the *Department of Pediatric Emergency Medicine, Monash Medical Centre; †School of Clinical Sciences at Monash Health; and ‡Department of Emergency Medicine, Royal Children's Hospital, Victoria, Australia.
Insights
A computerized reminder significantly increased splint application for pediatric upper limb fractures before X-ray. However, the intervention did not improve pharmaceutical analgesia provision in the emergency department.
Area of Science:
- Emergency Medicine
- Pediatric Orthopedics
- Health Informatics
Background:
- Deformed upper limb fractures in children often require prompt management.
- Standard care may not consistently ensure optimal pre-radiographic interventions like splinting.
Purpose of the Study:
- To determine if a computerized pop-up reminder enhances splint application before X-ray in pediatric emergency patients with upper limb fractures.
- To assess the impact of this reminder on pharmaceutical analgesia provision.
Main Methods:
- A prospective study involving 518 pediatric patients with upper limb fractures.
- Implemented a computerized pop-up reminder for analgesia and splinting.
- Compared data with a retrospective study of 1407 patients.
Main Results:
- Splint application rates increased significantly from 22% to 49% (P < 0.001) after the computerized reminder.
- No significant improvement in pharmaceutical analgesia provision within the first hour was observed.
Conclusions:
- Computerized reminders at X-ray ordering effectively improve splint application for pediatric upper limb fractures.
- The intervention did not impact pharmaceutical analgesia delivery.
- This cost-effective and user-friendly reminder system is potentially transferable.
Objective:
The primary objective was to assess if a computerized pop-up reminder increased splint application before X-ray in pediatric emergency department patients with deformed upper limb fractures. The secondary objective was to evaluate whether this same reminder improved pharmaceutical analgesia provision in this population.
Methodology:
This was a prospective study of 518 pediatric emergency department patients with upper limb fractures after the implementation of a computerized pop-up reminder to give analgesia and apply a splint. The records of those with fractures requiring manipulation were identified and reviewed for data on demographics, clinical characteristics, splint application, and analgesic use. These data were compared with that in a previous retrospective study of 1407 patients in the same population before implementation of the computerized reminder.
Results:
There were 86 patients with upper limb fractures requiring manipulation identified during the study period. After the computerized intervention, splint application rates improved from 22% to 49% (P = <0.001). There was no significant change to analgesia provision in the first hour after presentation.
Conclusions:
A computerized reminder at the point of X-ray ordering significantly improved splint application rates for children with deformed upper limb fractures, though it did not affect pharmaceutical analgesia provision. The computerized pop-up is cheap to implement, easy to use, and potentially transferrable to other institutions and for other uses.
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