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Comparison between a multicentre, collaborative, closed-loop audit assessing management of supracondylar fractures and the British Orthopaedic Association Standard for Trauma 11 (BOAST 11) guidelines.

Abstract Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves. Materials and Methods Stage 1: We conducted a multicentre, retrospective audit of adherence to BOAST 11 standard 1. Data were collected from eight hospitals in the United Kingdom. A total of 433 children with Gartland type 2 or 3 supracondylar fractures were eligible for inclusion. A centrally created data collection sheet was used to guide objective analysis of whether BOAST 11 standard 1 was adhered to. Stage 2: We created a quality improvement proforma for use in emergency departments. This was piloted in one of the hospitals used in the primary audit and was re-audited using equivalent methodology. In all, 102 patients presenting between January 2016 and July 2017 were eligible for inclusion in the re-audit. Results Stage 1: Of 433 patient notes audited, adherence to BOAST 11 standard 1 was between 201 (46%) and 232 (54%) for the motor and sensory function of the individual nerves specified, 318 (73%) for radial pulse, and 247 (57%) for digital capillary refill time. Stage 2: Of 102 patient notes audited, adherence to BOAST 11 standard 1 improved to between 72 (71%) and 80 (78%) for motor and sensory function of the nerves, to 84 (82%) for radial pulse, and to 82 (80%) for digital capillary refill time. Of the 102 case notes reviewed in stage 2, only 44 (43%) used the quality improvement proforma; when the proforma was used, adherence improved to between 40 (91%) and 43 (98%) throughout. Conclusion Adherence to BOAST 11 standard 1 is poor in hospitals across the country. This is concerning as neurovascular deficit may be an indication for emergent surgery, and missed neurovascular injury can cause long-term, or even permanent, functional impairment. We present a simple proforma that improves adherence to this standard, can easily be implemented into emergency departments, and may improve patient safety. Cite this article: Bone Joint J 2018;100-B:346-51.
PMID
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Authors

Mayor MeshTerms

Guideline Adherence

Medical Audit

Practice Guidelines as Topic

Keywords

BOAST guidelines

British Orthopaedic Standards for Trauma 11

Closed-loop audit

Fracture

Multicentre

Quality improvement

Supracondylar

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589502
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20180402
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - Comparison between a multicentre, collaborative, closed-loop audit assessing
      management of supracondylar fractures and the British Orthopaedic Association
      Standard for Trauma 11 (BOAST 11) guidelines.
PG  - 346-351
LID - 10.1302/0301-620X.100B3.BJJ-2017-0780.R2 [doi]
AB  - Aims Supracondylar fractures are the most frequently occurring paediatric
      fractures about the elbow and may be associated with a neurovascular injury. The 
      British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines
      describe best practice for supracondylar fracture management. This study aimed to
      assess whether emergency departments in the United Kingdom adhere to BOAST 11
      standard 1: a documented assessment, performed on presentation, must include the 
      status of the radial pulse, digital capillary refill time, and the individual
      function of the radial, median (including the anterior interosseous), and ulnar
      nerves. Materials and Methods Stage 1: We conducted a multicentre, retrospective 
      audit of adherence to BOAST 11 standard 1. Data were collected from eight
      hospitals in the United Kingdom. A total of 433 children with Gartland type 2 or 
      3 supracondylar fractures were eligible for inclusion. A centrally created data
      collection sheet was used to guide objective analysis of whether BOAST 11
      standard 1 was adhered to. Stage 2: We created a quality improvement proforma for
      use in emergency departments. This was piloted in one of the hospitals used in
      the primary audit and was re-audited using equivalent methodology. In all, 102
      patients presenting between January 2016 and July 2017 were eligible for
      inclusion in the re-audit. Results Stage 1: Of 433 patient notes audited,
      adherence to BOAST 11 standard 1 was between 201 (46%) and 232 (54%) for the
      motor and sensory function of the individual nerves specified, 318 (73%) for
      radial pulse, and 247 (57%) for digital capillary refill time. Stage 2: Of 102
      patient notes audited, adherence to BOAST 11 standard 1 improved to between 72
      (71%) and 80 (78%) for motor and sensory function of the nerves, to 84 (82%) for 
      radial pulse, and to 82 (80%) for digital capillary refill time. Of the 102 case 
      notes reviewed in stage 2, only 44 (43%) used the quality improvement proforma;
      when the proforma was used, adherence improved to between 40 (91%) and 43 (98%)
      throughout. Conclusion Adherence to BOAST 11 standard 1 is poor in hospitals
      across the country. This is concerning as neurovascular deficit may be an
      indication for emergent surgery, and missed neurovascular injury can cause
      long-term, or even permanent, functional impairment. We present a simple proforma
      that improves adherence to this standard, can easily be implemented into
      emergency departments, and may improve patient safety. Cite this article: Bone
      Joint J 2018;100-B:346-51.
FAU - Goodall, R
AU  - Goodall R
AD  - Bristol Medical School, University of Bristol, Senate House, Tyndall Avenue,
      Bristol BS8 1TH, UK.
FAU - Claireaux, H
AU  - Claireaux H
AD  - Oxford University Clinical Academic School, John Radcliffe Hospital, Headley Way,
      Headington, Oxford OX3 9DU, UK.
FAU - Hill, J
AU  - Hill J
AD  - Department of Paediatric Orthopaedics, Bristol Children's Hospital, Upper Maudlin
      Street, Bristol BS2 8BJ, UK.
FAU - Wilson, E
AU  - Wilson E
AD  - Bristol Medical School, University of Bristol, Senate House, Tyndall Avenue,
      Bristol BS8 1TH, UK.
FAU - Monsell, F
AU  - Monsell F
AD  - Department of Paediatric Orthopaedics, Bristol Children's Hospital, Upper Maudlin
      Street, Bristol BS2 8BJ, UK.
FAU - Boast Collaborative
AU  - Boast Collaborative
FAU - Tarassoli, P
AU  - Tarassoli P
AD  - Severn Deanery, Department of Orthopaedics, Royal United Hospitals Bath, Combe
      Park, Avon BA1 3NG, UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Child
MH  - Female
MH  - *Guideline Adherence
MH  - Humans
MH  - Humeral Fractures/*therapy
MH  - Injury Severity Score
MH  - Male
MH  - *Medical Audit
MH  - Peripheral Nerve Injuries/*prevention & control
MH  - *Practice Guidelines as Topic
MH  - Quality Improvement
MH  - Risk Assessment
MH  - United Kingdom
MH  - Vascular System Injuries/*prevention & control
OTO - NOTNLM
OT  - BOAST guidelines
OT  - British Orthopaedic Standards for Trauma 11
OT  - Closed-loop audit
OT  - Fracture
OT  - Multicentre
OT  - Quality improvement
OT  - Supracondylar
EDAT- 2018/03/29 06:00
MHDA- 2018/04/03 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0780.R2 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):346-351. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0780.R2.