gms | German Medical Science

Objectives/Interrogation: This is a retrospective study assessing the availability of adequate radiographic views of suspected phalangeal and metacarpal fractures in a busy emergency plastic surgery clinic. Furthermore, the study demonstrates how significant improvements in the availability and quality of radiological investigations available at the time of assessment in clinic can be obtained with a few simple interventions.

Methods: Patient data was retrospectively collected from electronic medical records over a two separate one-month periods - December 2017 and January 2018. The suspected diagnosis and availability of adequate radiological investigations were recorded. After the first month of data collection the results were presented at a departmental meeting and interventions were introduced to improve the quality of the service. The second data collection cycle was performed one month later to establish if the interventions improved the quality of the radiological investigations present at the time of outpatient assessment.

Results and Conclusions: In December 2017, 95 patients were seen in the trauma clinic with suspected phalangeal (68) and metacarpal (27) fractures of which 75% and 52%, respectively, had inadequate radiographic views for the correct examination of the underlying pathology. Furthermore, 62% of all XRs taken had inappropriate views.

In January 2018, 81 patients were seen in clinic with phalangeal (61) and metacarpal (20) fractures of which 48% and 45% respectively had inadequate XR views (mean 47%). 37% of XRs taken this month had inappropriate views.

X-rays are indispensable in hand fracture assessment and their absence leads to inadvertent delays in patient management. A significant number of patients attending the clinic who need radiographs for accurate assessment either do not have them taken in referring center or they are not sent on time. These situations lead to preventable delays in patient care by waiting for the transfer of images or result in unnecessary irradiation as the radiographs are repeated. Our study demonstrates that significant improvements in the availability and quality of radiological investigations at the time of the preoperative assessment can be made by introducing two simple interventions.