增加儿童骨科骨折护理的及时随访

C. Bishop, K. Dolan, J. Balch Samora
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引用次数: 0

摘要

背景:及时随访骨科专家的放射学和临床评估对于避免儿童长骨骨折后的潜在并发症至关重要。在我们的大型三级护理儿科医院,急诊科评估骨折复位后及时随访的基线率为74.4%。我们检验了我们可以使用质量改进(QI)方法来提高及时随访率和改善患者护理的假设。方法:实施多学科QI计划,对员工进行教育;改进程序;病人和家庭教育;以及为后续行动的潜在障碍确定和提供资源的方法。问卷调查结果已记录在案并制成表格。结果:在QI项目结束时,及时随访的患者率为78.5%,而基线为74.4%。接受并完成问卷的患者与未接受问卷的患者在随访方面没有统计学差异。对于完成问卷调查的患者,发现随访障碍的患者和没有发现随访困难的患者之间没有统计学差异。结论:骨折复位后,骨科临床及时随访的百分比改善甚微。尽管干预措施没有达到目标,但今后仍有机会改进及时的后续行动。证据水平:二级(前瞻性队列研究)。
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Increasing Timely Follow-up with Pediatric Orthopaedic Fracture Care
Background: Timely follow-up for radiographic and clinical evaluation with an orthopaedic specialist is critical in avoiding potential complications after pediatric long bone fractures. At our large, tertiary care, pediatric hospital, the baseline rate of timely follow-up after evaluation of reduced fractures in the emergency department was 74.4%. We tested the hypothesis that we could use quality improvement (QI) methods to increase the rate of timely follow-up and improve patient care. Methods: A multidisciplinary QI program was implemented with education for staff; improvement of procedures; patient and family education; and a method to identify and provide resources for potential barriers to follow-up. Questionnaire results were documented and tabulated. Results: At the end of the QI program, patient rates of timely follow-up were 78.5%, compared with the 74.4% baseline. There was no statistical difference in follow-up between patients who received and completed the questionnaire and those who did not. For patients who did complete the questionnaire, there was no statistical difference between those who identified a barrier to follow-up and those who did not identify any difficulty with follow-up. Conclusions: Minimal improvement was noted on the percentage of timely follow-up in the orthopaedic clinic after reduction of a fracture. Although the interventions fell short of their goals, future opportunities exist for improvement of timely follow-up. Level of Evidence: Level II (prospective cohort study).
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