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The Right Move: Improving post-immobilization outcomes in patients with non-surgically managed distal radius fracture - A Quality Improvement Study
Sarah Hobbs, CHT
1, Ryan Paul, MD
2; Norah Matthies, MD FRCSC
3(1)Toronto Western Hospital - University Health Network, Toronto, ON, Canada, (2)University of Toronto, Toronto, ON, Canada, (3)Toronto Western Hospital, Toronto, ON, Canada
Introduction: Distal radius fractures (DRF) are one of the most common fractures affecting patients young and old. Delays in return of function affect health-related quality of life (HRQOL and are costly from a work time-loss and physical therapy standpoint. Early intervention involving physical therapy exercises while in still in a cast may reduce stiffness in joints not affected by the injury resulting in earlier return to valued activities. The purpose of this study was to improve early functional outcomes in patients with non-surgically treated DRFs by encouraging early physical therapy exercises utilizing a multi-faceted quality improvement (QI) approach.
Methods: This QI project was a non-randomized, prospective, time-series study. Over a 6-month period, 54 patients were approached for initial study inclusion with 40 included in the final primary outcome analysis. A multi-disciplinary team was enlisted to complete diagnostics as outlined in the Institute for Healthcare Improvement (IHI) approach: Fishbone / 5 Why / Pareto. Information and feedback were gathered from patients, orthopedic surgeons, and cast technologists to informed change ideas. After a rigorous literature review, patient educational resources (PER) were created while sustainable distribution within this hospital system underwent multiple PDSA cycles before settling on a multimodal implementation with focus on patient-facing electronic medical record (EMR) application. Primary outcome included digit tip-to-palm distance (TTPD) at 6 weeks post-injury, a physical measurement associated with hand function.
Results: At 6 weeks, mean TTPD decreased from 2.2 to a new baseline of 0.15 cm, which was a substantial improvement in early digital range of motion. Compliance with PER distribution at initial patient visit was 94%. Patient mean satisfaction scores rose from 4.1 to 4.7 / 5. There were no deleterious effects noted.
Conclusion: This QI study demonstrates that by providing patients with early comprehensive educational resources, functional digital motion improves earlier. A positive effect on patient satisfaction is also noted. Creation and institution-specific distribution of PER, combined with local initiatives to support project sustainability, are simple and translatable.
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