A collaborative system to improve compartment syndrome recognition
| Autor: | Lauren G. Solan, Peggy Gainor, James J. McCarthy, Laurie Webster, Joshua K. Schaffzin, Heather Prichard, Krista Wolfe, Jennifer Bisig |
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| Rok vydání: | 2013 |
| Předmět: |
Quality management
Quality Assurance Health Care Psychological intervention Compartment Syndromes Risk Assessment Documentation Education Nursing Continuing Injury prevention medicine Humans Nurse Practitioners Child Ohio Retrospective Studies Patient Care Team Academic Medical Centers business.industry Electronic medical record Internship and Residency Extremities medicine.disease Hospitals Pediatric Quality Improvement Workflow Orthopedics Outcome and Process Assessment Health Care Turnover Models Organizational Pediatrics Perinatology and Child Health Extremity injury Acute Disease Practice Guidelines as Topic Wounds and Injuries Medical emergency Guideline Adherence Orthopedic Nursing business Program Evaluation |
| Zdroj: | Pediatrics. 132(6) |
| ISSN: | 1098-4275 |
| Popis: | BACKGROUND AND OBJECTIVE: Acute compartment syndrome (ACS) is a rare but serious complication of extremity injury that can cause permanent damage or death. ACS development is variable and unpredictable, and delay in recognition or treatment of ACS can lead to significant morbidity. Our objective was to create a reliable system for recognition of patients at risk and monitoring for ACS that could withstand frequent provider turnover. METHODS: Using the Model for Improvement, we identified key drivers and failure modes for 2 processes: resident and nurse practitioner proper order entry and bedside nurse proper documentation of monitoring. Interventions were tested in frequent plan–do–study–act cycles. Effective interventions were used in combination to test for sustainability. RESULTS: Proper order entry increased from 23% at baseline to 90%. Proper documentation for patients with correct orders increased from 15% to 70%. Individual interventions, including pocket card distribution, electronic medical record order set, and direct discussion by team leaders, were associated with improvement among residents but were not sustained with team turnover. Incorporating all 4 individual interventions into the on-boarding process for residents produced consistent success. Nursing documentation improved with education and maintenance of proper order entry. CONCLUSIONS: We built a reliable, sustainable system to recognize and monitor patients at risk for ACS. Interventions designed to minimally disrupt existing workflows were individually associated with improvement. We achieved sustainability through staff turnover when we incorporated the interventions into routine orientation for new staff. Hospitals can use existing orders and protocols to sustain surveillance for ACS and other acute conditions. |
| Databáze: | OpenAIRE |
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