An Educational Intervention to Improve Splinting of Common Hand Injuries

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• 作者：Giancarlo McEvenue ; MD ; Fiona FitzPatrick ; RT (Orthopaed) ; Herbert P. von Schroeder ; MD ; MSc ; FRCSC
• 关键词：education ; hand ; intervention ; splinting ; trauma
• 刊名：Journal of Emergency Medicine
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：50
• 期：2
• 页码：228-234
• 全文大小：914 K

文摘

Hand trauma is a top presenting complaint to hospital emergency departments (EDs) and can become costly if not treated effectively. The cornerstone for initial management of the traumatized hand is application of a splint. Improving splinting practice could potentially produce tangible benefits in terms of quality of care and costs to society.

Objectives

We sought to determine the following: 1) whether the present standard of ED splinting was appropriate and 2) whether a strategically planned educational intervention could improve the existing care.

Methods

We used a pre- and postprospective educational intervention study design. In the preintervention phase, patients referred to our hand clinic were assessed for injury and splint type. Splinting appropriateness was evaluated according to a predetermined hand surgeons' expert consensus. Next, an educational intervention was targeted at all ED staff at our institution. Postintervention, all patients were again evaluated for splint appropriateness. A follow-up evaluation was performed at 1 year to see the long-term effects of the intervention.

Results

The most common mechanism of injury of referred patients was falling (35%), and the most frequent injury was metacarpal fracture (40%). Splint appropriateness increased significantly postintervention from 49% to 69% (p = 0.048). At follow-up after 1 year, splinting appropriateness was 70% (p = 0.041).

Conclusion

Appropriate hand splinting practice is essential for hand trauma management. Our results show that an educational intervention can successfully improve splinting practice. This quality of care initiative was low-cost and demonstrated persistence at 1 year of follow-up.