The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre
<p>Introduction</p> <p>In high volume centres, audits are essential to ensure good surgical techniques and fracture fixations to avoid complications, revision surgeries and poor outcomes. A method to assess fixations for fractures of different regions employing different implants a...
| Main Authors: | , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Springer
2020
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| _version_ | 1797076614410928128 |
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| author | Rajasekaran, RB Jayaramaraju, D Agraharam, D Perumal, R Kamal, A Rajasekaran, S |
| author_facet | Rajasekaran, RB Jayaramaraju, D Agraharam, D Perumal, R Kamal, A Rajasekaran, S |
| author_sort | Rajasekaran, RB |
| collection | OXFORD |
| description | <p>Introduction</p>
<p>In high volume centres, audits are essential to ensure good surgical techniques and fracture fixations to avoid complications, revision surgeries and poor outcomes. A method to assess fixations for fractures of different regions employing different implants and surgical demands is a challenge. We present here a simple method of review and follow-up work flow of more than 6000 fixations every year that helped in improving outcomes and also provide training for residents and junior staff.</p>
<p>Materials and methods</p>
<p>The results of 6348 fracture fixations in 2014, led to a trauma review system in January 2015 to classify all fracture fixations by senior consultants into three categories: category A (good fixations); category B (acceptable fixations; need further follow-up); category C (poor/unacceptable fixations needing revision) combined with a teaching program. A strategy was evolved that included the following practices: (1) identifying ‘red flag’ fractures that led to frequent failures, (2) routine senior surgeons’ involvement in such fractures, (3) evolving ‘intra-operative checklists’, (4) requirement of senior surgeons’ intervention if there was a ‘fiddle time’ of more than 20 min, and (5) approval of post-fixation c-arm image by a senior person before closure. The impact of these rules on the fixations for 2015, 2016 and 2017 were prospectively analysed.</p>
<p>Results</p>
<p>In the years 2015, 2016 and 2017 the number of fracture fixations performed were 6579, 6978 and 7012, respectively. There was a significant increase (p < 0.001) in the number of category A fixations (87.7%, 94.6% and 96.3% in 2015, 2016 and 2017, respectively) and also a decrease in the number of category C fixations (2.23%, 0.7% and 0.2% in 2015, 2016 and 2017, respectively). The quality of fixations of the ‘red flag’ fractures also improved.</p>
<p>Conclusion</p>
<p>We present here a very effective, tested, simple and easily reproducible method of audit and follow-up work flow that can be used in all high turnover trauma centres to improve outcomes and can also serve as a teaching resource for junior staff.</p>
<p>Study design</p>
Prospective study.</p>
<p>Level of evidence</p>
<p>Level II.</p> |
| first_indexed | 2024-03-07T00:06:13Z |
| format | Journal article |
| id | oxford-uuid:77a04103-1a49-423b-a59b-290a0f28697a |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:06:13Z |
| publishDate | 2020 |
| publisher | Springer |
| record_format | dspace |
| spelling | oxford-uuid:77a04103-1a49-423b-a59b-290a0f28697a2022-03-26T20:25:23ZThe role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centreJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:77a04103-1a49-423b-a59b-290a0f28697aEnglishSymplectic ElementsSpringer2020Rajasekaran, RBJayaramaraju, DAgraharam, DPerumal, RKamal, ARajasekaran, S<p>Introduction</p> <p>In high volume centres, audits are essential to ensure good surgical techniques and fracture fixations to avoid complications, revision surgeries and poor outcomes. A method to assess fixations for fractures of different regions employing different implants and surgical demands is a challenge. We present here a simple method of review and follow-up work flow of more than 6000 fixations every year that helped in improving outcomes and also provide training for residents and junior staff.</p> <p>Materials and methods</p> <p>The results of 6348 fracture fixations in 2014, led to a trauma review system in January 2015 to classify all fracture fixations by senior consultants into three categories: category A (good fixations); category B (acceptable fixations; need further follow-up); category C (poor/unacceptable fixations needing revision) combined with a teaching program. A strategy was evolved that included the following practices: (1) identifying ‘red flag’ fractures that led to frequent failures, (2) routine senior surgeons’ involvement in such fractures, (3) evolving ‘intra-operative checklists’, (4) requirement of senior surgeons’ intervention if there was a ‘fiddle time’ of more than 20 min, and (5) approval of post-fixation c-arm image by a senior person before closure. The impact of these rules on the fixations for 2015, 2016 and 2017 were prospectively analysed.</p> <p>Results</p> <p>In the years 2015, 2016 and 2017 the number of fracture fixations performed were 6579, 6978 and 7012, respectively. There was a significant increase (p < 0.001) in the number of category A fixations (87.7%, 94.6% and 96.3% in 2015, 2016 and 2017, respectively) and also a decrease in the number of category C fixations (2.23%, 0.7% and 0.2% in 2015, 2016 and 2017, respectively). The quality of fixations of the ‘red flag’ fractures also improved.</p> <p>Conclusion</p> <p>We present here a very effective, tested, simple and easily reproducible method of audit and follow-up work flow that can be used in all high turnover trauma centres to improve outcomes and can also serve as a teaching resource for junior staff.</p> <p>Study design</p> Prospective study.</p> <p>Level of evidence</p> <p>Level II.</p> |
| spellingShingle | Rajasekaran, RB Jayaramaraju, D Agraharam, D Perumal, R Kamal, A Rajasekaran, S The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
| title | The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
| title_full | The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
| title_fullStr | The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
| title_full_unstemmed | The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
| title_short | The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
| title_sort | role of a trauma review system and development of intra operative checklists in improving the quality of fracture fixations in a high volume tertiary centre |
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