Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures

Abstract

IV.

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

“…distal radial buckle fractures and Type 1 supracondylar fractures). Evidence supports the safety of discharging uncomplicated paediatric fracture patients from orthopaedic care once the correct diagnosis is made with instructions provided to the parents as to when to remove immobilization and when to allow a return to high‐risk activities . However, healthcare providers have been slow to follow these recommendations .…”

“…Evidence supports the safety of discharging uncomplicated paediatric fracture patients from orthopaedic care once the correct diagnosis is made with instructions provided to the parents as to when to remove immobilization and when to allow a return to high-risk activities. [3][4][5][6] However, healthcare providers have been slow to follow these recommendations. 11 In our study, 29 of 66 new referrals that should have been triaged to the primary healthcare provider as per the pathways were inappropriately triaged to be seen in the fracture clinic.…”

“…Routine orthopaedic surgeon assessment and follow‐up are unnecessary for many uncomplicated paediatric fractures . However, a conservative approach of close clinical and radiographic follow‐up is often over‐utilized by clinicians with limited experience in paediatric orthopaedics, thereby increasing resource consumption unnecessarily .…”

“…Routine orthopaedic surgeon assessment and follow-up are unnecessary for many uncomplicated paediatric fractures. [3][4][5][6] However, a conservative approach of close clinical and radiographic follow-up is often over-utilized by clinicians with limited experience in paediatric orthopaedics, thereby increasing resource consumption unnecessarily. 7,8 This practice can increase the costs incurred by the hospital but can also place significant economic burden on families as accompanying parents have to take more time off from work.…”

“…7,8 This practice can increase the costs incurred by the hospital but can also place significant economic burden on families as accompanying parents have to take more time off from work. [6][7][8][9] In part to address the differences in management that potentially lead to over-treatment of paediatric fractures, the Victorian Pediatric Orthopaedic Network and the Royal Children's Hospital, Melbourne, created evidence based web-based paediatric fracture pathways for use in emergency departments and outpatient clinics by general practitioners, emergency room physicians, orthopaedic surgeons and their respective trainees (Figs S1,S2). 10 Web-based paediatric fracture pathways for upper extremity fractures were published on our institution's website in October 2012.…”