Enhancing Neurovascular Assessment Documentation in Paediatric Supracondylar Fractures: A Closed Loop Audit
Ahmed Mohamed1, Usman Fuad1, Sagaurav Shrestha1
1Trauma and Orthopaedics, Royal Cornwall Hospital, Truro, GBR.
Insights
Improving neurovascular documentation for paediatric humerus fractures is crucial. A UK hospital audit showed targeted education and proformas significantly boosted compliance with British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASts) guidelines.
Area of Science:
- Orthopaedic Surgery
- Paediatric Trauma
- Quality Improvement in Healthcare
Background:
- Paediatric supracondylar humerus fractures carry high risks of neurovascular complications.
- Proper assessment and documentation are vital to prevent long-term consequences.
- British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASts) guidelines stress comprehensive neurovascular evaluation.
Purpose of the Study:
- To evaluate and enhance adherence to BOASts guidelines for preoperative neurovascular documentation in paediatric supracondylar fractures.
- To assess the impact of targeted interventions on clinical documentation standards.
Main Methods:
- A retrospective closed-loop audit conducted in two cycles (Jan-Sep 2022 and Oct 2022-Jun 2023).
- Involved 24 patients in the first cycle and 34 in the second, all under 15 with supracondylar fractures.
- Interventions included staff education and standardized neurovascular assessment proformas.
Main Results:
- Compliance with BOASts guidelines increased significantly from 45.8% to 76.5% (p=0.017).
- Preoperative neurovascular compromise rates were 12.5% and 14.7%, with all cases resolving postoperatively.
- Postoperative complications occurred in one patient per cycle, both managed successfully.
Conclusions:
- Targeted educational initiatives and standardized documentation tools demonstrably improve compliance with neurovascular assessment guidelines.
- Quality improvement strategies enhance patient safety and clinical documentation in paediatric orthopaedic trauma.
- Systematic audits are effective in refining care standards for critical paediatric fractures.
Abstract:
Background and objective Paediatric supracondylar fractures of the humerus are associated with significant neurovascular complications that can result in devastating long-term consequences if not properly assessed and documented. The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASts) guidelines emphasise the critical importance of comprehensive neurovascular assessment in these patients. This closed-loop audit aimed to evaluate and improve compliance with BOASts guidelines for preoperative neurovascular documentation in paediatric supracondylar fractures at a District General Hospital in the United Kingdom. Methods A retrospective closed-loop audit was conducted over two cycles. The first cycle (January-September 2022) included 24 patients under 15 years with supracondylar fractures. Following implementation of targeted interventions, including staff education and introduction of standardised neurovascular assessment proformas, a second cycle (October 2022-June 2023) was conducted with 34 patients. Data were collected from electronic databases and analysed using Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results Compliance with the BOASts guidelines improved significantly from 45.8% (11/24 patients) in the first cycle to 76.5% (26/34 patients) in the second cycle (p = 0.017). Preoperative neurovascular compromise was identified in 12.5% (3/24) of patients in cycle one and 14.7% (5/34) in cycle two, with all cases resolving postoperatively. One patient in each cycle experienced postoperative neurovascular complications, both of which were successfully managed. Conclusion Implementation of targeted educational interventions and standardised documentation tools significantly improved compliance with the BOASts guidelines for neurovascular assessment in paediatric supracondylar fractures. This audit demonstrates the effectiveness of systematic quality improvement initiatives in enhancing patient safety and clinical documentation standards.
