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Introduction

Application of clinical pathway using EMR system in pediatric patients with supracondylar fracture of the humerus : A before and after comparative study. Introduction.

chester-lott
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Introduction

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  1. Application of clinical pathway using EMR system in pediatric patients with supracondylar fracture of the humerus : A before and after comparative study

  2. Introduction A clinical pathway (CP) is an “optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure.”

  3. A CP can provide high quality of medical treatment and minimize the unnecessary medical practice, so it can enhance the treatment efficiency. • CP can improve the patients’ and their guardian’s satisfaction by a predictable medical treatment.

  4. A supracondylar fracture of the humerus is the most common fracture in children. The mainstream treatment for a displaced supracondylar fracture is a closed reduction and internal fixation using a percutaneous pinning.

  5. To investigate the usefulness of clinical pathway (CP) using an electronic medical record (EMR) in pediatric patients undergoing closed pinning for supracondylar fracture of the humerus, by analyzing the length of hospital stay, hospital cost and satisfaction of the medical teams. Purpose

  6. The treatment using CP would be not inferior to previous treatment in terms of the length of hospital stay and hospital cost, and that the implementation of CP could increase medical team’s satisfaction by standardizing the treatment. Hypothesis

  7. Method

  8. Before and after comparative study Approved by IRB

  9. Inclusion criteria • Consecutive children, who underwent closed reduction and internal fixation with percutaneous pinning for supracondylar fracture of the humerus, since March 2009

  10. Exclusion criteria • Patients who underwent open reduction and internal fixation • patients with open fracture or concomitant injury, which requires longer hospital stay

  11. Allocation of patients • Pre-CP group • Patients who underwent closed pinning between March 2009 and April 2011, before the implementation of CP • Post-CP group • patients who underwent closed pinning between May 2011 and May 2012, after the implementation of CP

  12. Development of CP • Multidisciplinary work-team involving orthopedic surgeons, nursing staffs, quality assurance (QA) team, and a computation team. • Orthopedic surgeons and nursing staffs developed an optimal regimen of the treatment processes. -> target a 3-day length of hospital stay • The contents of the pathway were reviewed and the implementation of pathway was approved by the committee.

  13. Implementation of CP • The CP was implemented using an EMR system in May 2011. • Preoperative evaluation was performed. • Patients and their guardians were informed by the orthopedic resident concerning the perioperative schedules. • Lateral pinning technique using 2 pins was used for the fixation of supracondylar fracture of the humerus.

  14. Satisfaction survey • Questionnaires evaluating the medical team’s satisfaction of the implementation of CP • 10 items using the 5-point Likert scale • Satisfaction questionnaires • Before the implementation of CP (41 medical team members) • 1 year after the implementation of CP (35 medical team members)

  15. Outcome variable • Primary outcome variable • Total length of hospital stay • Secondary outcome variable • Total hospital cost and medical team’s satisfaction score

  16. Sample size estimation • Non-inferiority test • Assumption that a mean between-group difference in hospital stay of 0.5 day was considered clinically significant and SD of 0.7 day • 90% power, a one-sided type 1 error rate of 0.05 and allocation ratio of 1:3

  17. Statistical methods • Non-inferiority margin • 10% of the mean values of the length of hospital stay and total hospital cost in pre-CP group • -0.3 day and -116 US$ • If non-inferiority was shown, the p value associated with a superiority test was calculated • Mann-Whitney U test or independent t-test according to data normality

  18. Results

  19. Comparison of patient demographics and clinical characteristics between pre-CP group and post-group

  20. Comparison of the length of hospital stay between pre-CP group and post-group Lower bound of the 95% CI of the difference of 0.14 day did not exceed the non-inferiority margin of -0.3 day.

  21. Comparison of the hospital cost between pre-CP group and post-group Lower bound of the 95% CI of the difference of -78.5 US$ did not exceed the non-inferiority margin of -116 US$.

  22. Comparison of the medical team’s satisfaction between pre-CP group and post-group

  23. Conclusion The development and implementation of CP, using an EMR, in pediatric patients undergoing closed pinning for supracondylar fracture of the humerus enhances the treatment efficiency by streamlining the treatment process with no increases of the length of the hospital stay and total hospital costs.

  24. Thank you !

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