An Intervention to Promote Optimal Care of Pediatric Patients with Suspected Elbow Fracture
Maria Carmen G Diaz1, Lloyd N. Werk2, Tim Wysocki3
1Nemours/Alfred I duPont Hospital for Children, Wilmington, DE;2Nemours Children's Hospital, Orlando, FL;3Nemours Center for Healthcare Delivery Science, Jacksonville, FL
Background (issue): Emergency Department(ED) and Urgent Care(UC) physicians’ accurate assessment of the neurovascular and musculoskeletal(NV/MSK) exam in pediatric patients with suspected elbow fracture(SEF) is crucial to the early recognition of neurovascular compromise. We implemented a quality improvement project to promote accurate NV/MSK assessment of these patients by ED/UC physicians.
Methods: All participants received an initial computer based simulation (CBS) training about assessment of SEF. After completing the CBS, a group of ED/UC physicians was randomized to receive computerized clinical decision support system (CCDSS) and the other group received no further pre-planned intervention. The CCDSS included electronic best practice alerts and documentation prompts embedded within the electronic medical record (EMR). Participants received feedback in four week intervals about their proportion of patients seen with elbow fractures with complete examinations documented in the EMR.
Findings: 28 ED and UC physicians took part in this 16-week project; 14 in each arm. Compared to single CBS training alone, repeated exposure to CCDSS after CBS training resulted in improved documentation of NV/MSK exam of pediatric patients with elbow fracture (88% versus 24%).
Conclusions (implications for practice): CCDSS received at the point of care are effective in improving ED and UC physicians’ documentation of the NV/MSK exam of pediatric patients with elbow fractures. Future studies are needed to analyze the effects of frequent and recurrent CBS on physicians’ documentation of the NV/MSK exam of these patients.
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