Orthopaedic Admission Research Articles

Do multidisciplinary team members correctly interpret the abbreviations used in the medical records?

Background and Aims Abbreviations are commonly used in the medical world to save time and space whilst writing in the patients’ case notes. As various specialties have evolved, each has developed a collection of commonly used abbreviations within its practice, which may not be easily recognisable to those working as an allied branch. The purpose of this study was to assess whether we, the multidisciplinary team members, interpret the abbreviations used in the medical records correctly? Methods and Results We analysed orthopaedic inpatient admission case notes (n = 45) for the use of abbreviations (n = 57) and their appreciation by different members of the multidisciplinary team (n = 175) by means of a standardised questionnaire. We found a wide variation in understanding and interpretation of orthopaedic abbreviations among health care professionals. Even the orthopaedic surgeons could answer correctly 57.2% only, followed by physiotherapists (49.9%). Non-orthopaedic groups produced significantly less number of correct answers than the orthopaedic surgeons (p <0.019). Interestingly, nursing and physiotherapy departments produced significantly fewer mal-interpretations than the orthopaedic surgeons (p <0.023). Conclusions Whilst abbreviations may indeed save time, the use of confusing abbreviations is unacceptable. We recommend that acronym obsession should be discouraged in order to reduce possible clinical error.

The impact of a temporary ice-rink on an emergency department service

A temporary ice-rink opened close to Cork city for 6 weeks from 30 November 2003. During this time, a number of patients presented to the local emergency departments with ice-skating-related injuries. We documented these injuries. All patients presenting to emergency departments in Cork city with ice-skating-related complaints were included. Information on age and sex, mechanism of injury, diagnosis, follow-up/disposition and ambulance service utilization was recorded. One hundred and twenty-five ice-rink-related attendances were reported at Cork emergency departments, representing 1.25% of total attendances. One hundred and twenty-three patients presented with skating-related injuries and two with medical complaints occurring at the ice-rink: 70.8% were female patients and 29.2% were male patients. In the 4-14-year age group, however, 48.5% were girls and 51.5% were boys. Most injuries were directly due to falls; 5.6% were due to skate blades. The commonest site of injury was the upper limb. Fractures and dislocations accounted for 53.9% of injuries, with 20.5% of these requiring orthopaedic admission. Lacerations and digital injuries accounted for 7.1%, with 11% of these required admission for surgery. One minor head injury was reported. 38.1% had soft tissue injuries. Fifteen patients were transported by ambulance. These attendances represented a minimum overall cost of 77,510 euro to the local health service. A temporary ice-rink had a significant impact on local emergency departments. Currently, there is no specific legislation in Ireland relating to public health and safety in ice-rinks. We recommend consultation with local public bodies before opening such facilities, and appropriate regulation.

A Retrospective Study of Patients Discharged within 24 Hours after Emergency Admission in a Public General Hospital

Objectives To identify the epidemiological characteristics and outcome of patients who were discharged within 24 hours of emergency admission, and to explore methods to reduce inappropriate admission. Design Retrospective study. Setting Emergency admission in a public general hospital in Hong Kong. Patients Four hundred and ninety-one cases collected in a three-month period from 1st April 2000 to 30th June 2000, excluding those who died within 24 hours of admission. Main outcome measures Patients' epidemiological and clinical characteristics, specialty of admission, in-patient procedures performed, diagnosis upon discharge and destination of patients. Results During the study period, 8.8% of the 5,587 emergency admissions were discharged within 24 hours. Most of them were middle-aged males, triaged as category 3 and 4 non-trauma cases. The percentage of emergency Orthopaedic and Surgical admission resulting in discharge within 24 hours was 18.5% and 16.2% respectively, substantially higher than the percentage of emergency Medical and Paediatric admission (5.5% and 4.7% respectively). The most common diagnoses included orthopaedic open soft tissue injuries, orthopaedic closed fractures and dislocations, head injury, drug overdose, abdominal pain, ischaemic heart disease or chest pain and foreign body in throat. Overall, 20.8% of cases received some forms of orthopaedic procedures, 9% had computed tomography (CT) brain done, and 5.5% had OGD performed. Around 90% of cases with orthopaedic open soft tissue injuries and closed fractures or dislocations received intervention, 73% of head injury cases had CT brain done, and around 63% of patients with foreign body in throat received oesophago-gastroduodenoscopy (OGD). Overall, 14% of cases discharged themselves against medical advice or walked away after admission. Up to 9.8% were transferred to other hospitals within 24 hours. Around 54.8% were followed up in hospital after discharge, and re-admission was planned in 2.9% for elective procedures. Only 13 cases (2.6%) were re-admitted through A&E within one week with the same diagnosis into the same specialty. Conclusions The issue of ‘discharge within 24 hours’ should not automatically be regarded as inappropriate emergency admission. Upgrade of professional training and clinical supervision, improvement of administrative arrangement and clinical audit are possible measures to enhance the efficiency of hospital utilization.

Managing delirium and agitation in elderly hospitalized orthopaedic patients: Part 2--Interventions.

Delirium, a disorder of consciousness that may afflict over one-half of elderly surgical orthopaedic patients is a common sequela of surgery in the elderly. Agitation, either as an element of the delirium or dimension of a preexisting dementia, is another common behavioral problem that can confront the orthopaedic nurse in acute care. It is time now to tear down the barriers to intelligent and compassionate care of patients with agitation and delirium, including late or missed recognition and diagnosis, biases about what is "normal" and acceptable behavior in the elderly, and lack of familiarity with pharmacologic strategies. In Part 1 (Jan/Feb issue), current thinking about the phenomena was presented, including hypotheses about causation and pathophysiology. That foundation is intended to serve as the basis for the current discussion. The triad of interventions available to manage disorganized behavior in elderly orthopaedic patients is presented in Part 2. They include an extensive selection of pharmacologic options, a discussion of therapeutic use of self and environmental-organizational issues to address and consider on a case-by-case basis. Though it may be impossible to prevent behavioral decompensation during an acute orthopaedic admission, it is certainly possible to improve our performance to date, using a compassionate, intelligent, and inclusive approach with every patient.

Measuring outcomes from the patients' perspective.

This descriptive study examines the outcomes of care from the perspective of patients following a recent orthopaedic admission at a teaching hospital in Sydney. Results were extracted and analysed from transcripts of audio-taped focus groups. Participants identified five nursing activities that made a positive difference to patient outcomes. These activities were: (i) patient-controlled analgesia; (ii) water-filled gloves placed under patients' heels; (iii) cream rubbed into patients' heels; (iv) an explanation, at pre-admission clinic, of the impending operation; and (v) being informed about the details of their treatment while in hospital. Three activities that participants felt made a negative difference to their outcome were also identified, as were seven activities not performed by nursing staff that participants felt would have made a positive difference to their outcome. The results from this study reinforce the importance of basic nursing care, and the value of measuring outcomes, not only from the professional perspective, but also from the patients' viewpoint.

The Allied Health BONE (Best Orthopaedic New Enterprise) team: an interdisciplinary approach to orthopaedic early discharge and admission prevention.

This paper presents the conceptual framework, activities and outcomes of the Allied Health BONE (Best Orthopaedic New Enterprise) Team, an early discharge incentive at the Gold Coast Hospital. The clinical team of a physiotherapist, occupational therapist and social worker provided services within an interdisciplinary model of care with the aim of reducing the length of stay of acute adult orthopaedic patients. The team provided intervention in the community, the accident and emergency department, pre-admission clinic and orthopaedic wards to patients with hip and knee replacements, back pain and upper femoral fractures. This paper reports data from the first six months of the project, demonstrating success in improving the continuity of care provided to orthopaedic patients and reducing the length of stay in target groups by 24%.

A protocol to improve analgesia use in the accident and emergency department.

To assess the use of analgesia in an accident and emergency (A&E) department and identify shortcomings. University teaching hospital. An audit of patients referred from the A&E department to orthopaedic fracture clinic (n = 100) or for orthopaedic admission (n = 100) was carried out to document analgesia use. An analgesia protocol was introduced and analgesia use was reassessed on the same numbers of patients. Prescribing of analgesia was initially poor: 91% of fracture clinic referrals and 39% of admissions received no analgesia while in the A&E department; when given, it was often by inappropriate routes. Introduction of an analgesia protocol significantly improved analgesia use: fracture clinic referrals receiving unsatisfactory analgesia were reduced from 91% to 69% (P < 0.001). There was a marked increase in the use of intravenous analgesia, from 9% to 37% (P < 0.001). Large numbers of patients still receive no analgesia while in the A&E department. This seems to be a common problem requiring intervention at a national level. The absence of a coordinated approach to improving analgesia provision for acute trauma in the United Kingdom should be addressed urgently.