Quality of Documentation in Paediatric Supracondylar Fractures: A Quality Improvement Project
Vusumuzi Sibanda1, Marjan Raad2, Peter I Legg1
1Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR.
Insights
Implementing a documentation proforma improved neurovascular documentation for pediatric supracondylar elbow fractures. This quality improvement project showed early success in enhancing patient care standards.
Area of Science:
- Orthopaedic Surgery
- Pediatric Trauma
- Quality Improvement in Healthcare
Background:
- Supracondylar fractures are the most common elbow fractures in children, requiring meticulous documentation and management.
- Adherence to established standards, such as the British Orthopaedic Association Standards for Trauma (BOAST), is crucial for optimal patient outcomes.
Purpose of the Study:
- To assess and improve the quality of documentation for pediatric supracondylar fractures.
- To evaluate the effectiveness of a quality improvement intervention, including a documentation proforma and multidisciplinary teaching, in enhancing fracture care.
Main Methods:
- A case series of pediatric supracondylar fractures was analyzed retrospectively (pre-intervention) and prospectively (post-intervention).
- A quality improvement intervention involving a documentation proforma and multidisciplinary teaching was implemented.
- Data on neurovascular documentation and time to surgery were compared pre- and post-intervention.
Main Results:
- Post-intervention, there was a reduction in "no neurovascular documentation" (17% vs 12%) and an increase in documented "neurovascular status intact" (44% vs 69%).
- Post-operative neurovascular assessment documentation improved significantly (50% vs 73%).
- The mean time to surgery decreased post-intervention (1.3 days vs 0.96 days).
Conclusions:
- The quality improvement project demonstrated early success in improving documentation quality for pediatric supracondylar fractures.
- Documentation proformas are effective tools for implementing positive change in clinical practice.
- Continuous clinical education for multidisciplinary teams is essential for managing trauma effectively.
Abstract:
Introduction Supracondylar fractures are the most common elbow fractures in children. Their documentation and management must be done fully and correctly. This Quality Improvement Project (QIP) assessed the quality of documentation for paediatric supracondylar fractures admitted, in accordance with the British Orthopaedic Association Standards for Trauma (BOAST). Methods We present a case series of supracondylar fractures presenting to a single UK-based district general hospital from January 2018 - October 2021. We performed a quality improvement intervention starting in November 2020. The retrospective data prior to intervention (January 2018-November 2020) were deemed "pre-intervention". Prospective "post-intervention" data were collected from April to October 2021. After "pre-intervention" data analysis, an intervention in the form of a documentation proforma was developed and multidisciplinary teaching sessions were delivered. Post-intervention prospective data collection followed from April - October 2021. Results There were 48 and 26 patients in cycles one and two, respectively. The mean age was 6.4 (SD 3.5) and 6.5 (SD 2.7) years, respectively; 42/48 in cycle one and all 26/26 in cycle two required operative management. The mean time to surgery was 1.3 and 0.96 days, respectively. Post-intervention, cycle two showed a reduction in patients with "no neurovascular documentation" pre-reduction (17% vs 12%) and an increase in patients documented as having "neurovascular status intact" (NVI) (44% vs 69%). In post-operative documentation, there was an improvement in documentation with 73% of patients having a post-operative neurovascular assessment documented, versus 50% in the pre-intervention cohort. Conclusion This QIP provided some early improvement in the documentation but with room for future progress as the project continues. It showed proformas can be an effective tool in implementing positive change. It also highlights the need for continuous clinical education across the multidisciplinary teams managing trauma.
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