Related Experiment Video
Updated: Jun 18, 2025
Sequential In vivo Imaging of Osteogenic Stem/Progenitor Cells During Fracture Repair
Published on: May 23, 2014
Using Children's Artwork to Improve Adherence with Timely Antibiotic Administration in Open Fractures
Kathy Chu1, Shahriar Zehtabchi1, Valery Roudnitsky1
1Department of Emergency Medicine, Department of Trauma Surgery, NYC Health + Hospitals/Kings County, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Insights
Displaying children's artwork in the emergency department (ED) significantly improved adherence to early antibiotic administration for open fractures (OFs). This novel approach reduced the time to antibiotics, enhancing patient care and reducing infection risk.
Area of Science:
- Trauma Surgery
- Infectious Disease Prevention
- Patient Safety
Background:
- Early antibiotic administration within 60 minutes of emergency department (ED) arrival is crucial for reducing infection risk in open fracture (OF) patients.
- Adherence to timely antibiotic protocols can be challenging in busy trauma settings.
- Novel interventions are needed to improve clinician compliance with evidence-based guidelines for OF management.
Purpose of the Study:
- To evaluate the effectiveness of displaying children's artwork as a novel method to improve clinician adherence to early antibiotic administration for open fractures (OFs).
- To assess the impact of this intervention on the time to antibiotic administration in open fracture patients.
Main Methods:
- A registry-based, pre- and post-intervention study was conducted at a level 1 trauma center.
- The intervention involved displaying children's artwork depicting open fractures in the ED, alongside guidelines, and emailing reminders to clinicians.
- The primary outcome measured was the proportion of OF patients receiving antibiotics within 60 minutes of ED arrival, with time to antibiotics analyzed as a continuous variable.
Main Results:
- A total of 554 open fracture patients were analyzed (281 pre-intervention, 257 post-intervention).
- The percentage of patients receiving antibiotics within 60 minutes significantly increased from 58% (95% CI, 52%-63%) pre-intervention to 79% (95% CI, 74%-84%) post-intervention (P = 0.001).
- The median time to antibiotic administration decreased from 46 minutes pre-intervention to 25 minutes post-intervention (P = 0.001).
Conclusions:
- Displaying children's artwork in the emergency department is an effective and novel strategy to improve adherence to open fracture guidelines.
- This intervention significantly reduced the time to antibiotic administration for open fracture patients.
- The findings suggest that simple, visually engaging methods can positively impact clinical practice and patient outcomes in trauma care.
Introduction:
Antibiotics for open fractures (OFs) administered within 60 min of emergency department (ED) arrival reduce patients' infection risk. We tested a novel method of displaying children's drawings to prompt clinicians to improve adherence with early antibiotics for OFs.
Methods:
Registry-based pre- (January 1, 2016-June 30, 2019) and post- (July 1, 2019-March 31, 2022) intervention at a level 1 trauma center. In July 2019, children's artwork depicting OF was displayed in the ED alongside OF guidelines and E-mailed to faculty and residents. Primary outcome: proportion of OF patients who received antibiotics within 60 min of arrival. Time to antibiotics was calculated from ED arrival to time-stamped administration in the electronic health record. We compared time to antibiotics as continuous variables between the two groups. Proportions are presented with percentages and 95% confidence interval (CI); continuous variables as median and quartiles. Chi-square or Mann-Whitney U-tests were used for group comparisons.
Results:
Five hundred fifty-four total OF patients were identified (excluded: transferred = 1, ED death = 4, unclear time to antibiotics = 11); 281 pre-implementation and 257 post-implementation. The median age was 34 years (quartiles 24 and 46). Trauma mechanisms of injury included 300 blunt (56%) and 238 penetrating (44%). Gustilo OF classification by type were as follows: 71% I, 13% II, 15% III, 1% unclassified. There was a significant difference (P = 0.001) in both percentage of patients who received antibiotics within 60 min (58%, 95% CI, 52%-63% vs. 79%, 95% CI, 74%-84%) and time to antibiotics (median: 46 min vs. 25 min) between pre- and postphases, respectively.
Conclusions:
Children's artwork in our ED improved adherence with OF guidelines and decreased time to antibiotics.
