O118 Timing of surgery in open hand fractures - a single centre, closed-loop audit

Abstract

Abstract Introduction The British Society for Surgery of the Hand (BSSH) standards dictate the management of open hand fractures (OHFs). A wound washout and closure (WWC) in an OHF should take place within 24 hours of injury if definitive treatment is not possible in that timeframe. Methods A retrospective cross-sectional design was used to collect data from patients with OHFs. Data was taken from Cerner® EPR, Powerchart. Information was gathered about the date and type of surgery, whether surgery took place within 24 hours and, or whether WWC took place within the 24 hour timeframe. Two 3-month audit cycles were carried out: 03/12/2021–24/03/2022 (Cycle 1) and 24/03/2022–24/05/2022 (Cycle 2). Between cycles, simple interventions were implemented, including the distribution of flyers amongst departmental staff and weekly announcements in departmental meetings. Results Cycle 1 analysed 5 patients with OHFs. Of these patients, 60% (n=3) had definitive surgery within 24 hours and 40% (n=2) had neither definitive surgery nor WWC. Cycle 2 included 13 patients with OHF. Of these, 53.8% (n=7) had definitive surgery within 24 hours, 46.2% (n=6) did not have definitive surgery but had WWC and 16.7% (n=1) did not have surgery or WWC within 24 hours. Conclusion There was a 30% improvement in the cases for which BSSH guidelines were followed. Simple interventions can lead to significant change in compliance with gold-standards. We aim to conduct further cycles and include other units to assess multi-centre compliance.