Multifaceted quality improvement initiatives improve rate of pediatric hand injury reduction

• Published in: Canadian journal of emergency medicine 2022-06, Vol.24 (4), p.426-433
• Main Authors: Market, Marisa, Zhu-Pawlowsky, Julia, Bhatt, Maala, Cheung, Kevin
• Format: Article
• Language: English
• Subjects: Child; Electronic health records; Emergency Medicine; Emergency Service, Hospital; Fractures, Bone - epidemiology; Fractures, Bone - therapy; Hand Injuries - epidemiology; Hands; Humans; Injuries; Medical records; Medicine; Medicine & Public Health; Pediatrics; Public Health; Quality Improvement; Quality Improvement and Patient Safety (QIPS)
• ISSN: 1481-8035; 1481-8043
• DOI: 10.1007/s43678-022-00279-z

Background Hand fractures account for a significant proportion of all fractures seen in pediatric emergency departments (ED). It is essential for initial interventions to be successful to avoid unnecessary repeat interventions/complications. We sought to assess whether quality improvement interventions could decrease the rate of repeat reductions by plastic surgeons in our tertiary centre. Methods We included patients ≤ 18 years of age who presented to ED with a hand injury from January 2014 to May 2019. Data were collected and presented over two plan-do-study-act cycles. The interventions comprised the dissemination of previous research identifying hand injuries requiring repeat reduction at our centre and commencement of a quality improvement initiative that coincided with hiring of a fellowship-trained pediatric hand surgeon and the implementation of an electronic medical record. In the second plan-do-study-act cycle, we implemented formal educational workshops for ED physicians and a standardized flowsheet in our electronic medical record to track patients with hand injuries. Results We identified 272 hand injuries (136 in cycle 1, 136 in cycle 2) from January 2014 to May 2019. As a result of the implemented quality improvement initiatives, the proportion of hand injuries requiring repeat reduction decreased from 8.7% ( n  = 8) to 3.0% ( n  = 2) during cycle 1. This improvement was sustained during the 17-month-long (November 2017–May 2019) second cycle (3.0%, n  = 6). Conclusion This study highlights the importance of multifaceted interventions to achieve improved patient care, specifically the potential impact of specialized physicians, informal feedback and education, formal teaching workshops, and electronic medical records.