A Quality Improvement Initiative Reduces Cast Complications in a Pediatric Hospital
Julie Balch Samora1,2, Walter P Samora1,2, Kevin Dolan1
1Department of Orthopedic Surgery, Nationwide Children's Hospital.
Insights
Quality improvement initiatives significantly reduced pediatric casting complications by over 90%. This approach enhanced patient care by standardizing cast application and removal procedures.
Area of Science:
- Pediatric Orthopedics
- Healthcare Quality Improvement
- Patient Safety
Background:
- Casting is a common pediatric orthopedic treatment with inherent complication risks.
- The baseline complication rate was 5.6 per 1000 casts (0.56%) at a tertiary pediatric hospital.
- A hypothesis was formed to reduce casting complications using quality improvement (QI) methods.
Purpose of the Study:
- To decrease the overall cast complication rate.
- To improve patient care through a structured QI program.
- To implement standardized safe casting practices.
Main Methods:
- A QI program was implemented using Plan-Do-Study-Act cycles.
- A resident casting education program with a competency checklist was developed.
- AquaCast Saw Stop Protective Strips were mandated for all cast applications.
Main Results:
- The multimodal QI intervention reduced the cast complication rate to 1.61 per 1000 applications.
- This represents a significant improvement of over 90% in safety outcomes.
- Standardized procedures and safety measures were effectively implemented.
Conclusions:
- QI methodology effectively reduced pediatric cast complications.
- The initiative led to a demonstrable improvement in overall patient care.
- Standardized and safe casting practices are crucial in pediatric orthopedics.
Background:
Casts, while frequently used as routine treatment in pediatric orthopaedic practice, are not without complications. At our large tertiary care pediatric hospital, the baseline rate of all casting complications was 5.6 complications per 1000 casts applied (0.56%). We tested the hypothesis that we could use quality improvement (QI) methodology to decrease the overall cast complication rate and improve patient care.
Methods:
We initiated a QI program implementing concepts derived from the Institute for Healthcare Improvement models, including Plan-Do-Study-Act cycles, to decrease our cast complication rate. A resident casting education program was developed with a competency "checklist" to ensure that casts are applied, bivalved, and removed in a safe and standardized manner to prevent patient harm. AquaCast Saw Stop Protective Strips were required to be applied with every cast application. A review of our facility's processes and procedures determined adequate measures were in place to effectively manage inventory and maintenance of cast-saw blades.
Results:
With the multimodal QI intervention, our cast complication rate was reduced to 1.61 complications per 1000 applications, a >90% improvement.
Conclusions:
Implementation of QI concepts to perform a QI initiative resulted in a shift toward fewer cast complications, leading to overall improved patient care at a large tertiary pediatric hospital.
Level Of Evidence:
Level II-prospective cohort study.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:20Acute Kidney Injury V: Interprofessional Care
01:27Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
01:29Endocarditis IV: Nursing Management