Impact of web‐based clinical practice guidelines on paediatric fracture clinics

• Published in: ANZ journal of surgery Vol. 88; no. 3; pp. 232 - 235
• Main Authors: Camp, Mark W., Barnes, James R., Damany, Mohita, Donnan, Leo T.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.03.2018; Blackwell Publishing Ltd
• Subjects: Adolescent; Ambulatory Care Facilities - standards; Ambulatory Surgical Procedures - standards; Australia; Child; Child, Preschool; Children; Children & youth; clinical guidelines; Clinical practice guidelines; Cohort Studies; Emergency medical services; Female; Fractures; fractures (bone); Fractures, Bone - diagnostic imaging; Fractures, Bone - surgery; Hospitals, Pediatric; Humans; Internet; Male; Orthopedic Procedures - methods; Outcome Assessment (Health Care); outpatient clinic; paediatrics; Patients; Practice Guidelines as Topic; Radiology; Resource utilization; Retrospective Studies; urgent care clinics; paediatrics; outpatient clinic; clinical guidelines; urgent care clinics; fractures (bone)
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.14260

Background In an effort to standardize management and reduce over‐treatment of uncomplicated paediatric fractures, the Victorian Pediatric Orthopaedic Network and the Royal Children's Hospital, Melbourne, created publically available web‐based paediatric fracture pathways. The aim of this study was to determine the impact of web‐based fracture pathways on the clinic volume at a tertiary‐care paediatric fracture clinic. Methods A comparative retrospective review was performed at a large, urban, tertiary‐care children's hospital. Fracture clinic data from two 12‐week periods before and after implementation of the fracture pathways were compared. For each study period, data collected included: total number of emergency department visits, number of fracture clinic visits, number of fracture clinic visits for patients that presented with upper extremity fractures for which web‐based fracture pathways were available, number of radiology department visits for X‐rays, and number of fracture clinic visits for patients requiring orthopaedic intervention in the operating room (closed or open reductions). Results The number of fracture clinic visits for patients with upper extremity fractures decreased 12% post‐pathway implementation, from 954 visits to 842 visits. The number of radiology department visits for patients with upper extremity fractures decreased 24% post‐pathway implementation, from 714 to 544 visits. Conclusion The implementation of web‐based fracture pathways for upper extremity paediatric fractures was associated with a decrease in clinic resource utilization at a tertiary‐care children's hospital.