What is DDH?

1. Multimedia Health Education Can It Change Clinical Practice?Assoc Prof Leo DonnanDirector of Orthopaedics Chief of Surgery RCH

2. What is DDH? • A condition of the childs hip where there is incomplete development • Range of disorders including - instability, subluxation and dislocation

3. If unstable hips are not detected and treated they may - not develop properly and eventually fail

4. The Impetus to do something • In Victoria children are still presenting with a late diagnosis of hip dislocation despite screening programs and use of ultrasound • Children facing lifelong disability from a condition that is easily managed if detected early

5. Victorian Screening Program • 72,000 births per year • Geographically Spread • 4.0 million in Melbourne • 2.0 million in the “bush”

6. Clinical examination • at birth • six weeks • regular intervals up to age two • Ultrasound • abnormal clinical findings • risk factors at six weeks

7. The Problem • Poor documentation • No uniform standard of examination • Inconsistency in terminology • Increased reliance on imaging • Unclear referral mechanisms • Multiple examiners

8. The Scale of things • 72,000 births per year • Expect • 72 frank dislocations • 720 unstable hips • ???? dysplastic hips • 1012 MCH nurses in full/part time positions • large work force • dispersed • will see very low rates of dislocation • hrad to maintain skills

9. The Solution ? • Target the front line clinicians • Understand their difficulties • Define the barriers to early detection • Develop evidence based practice guidelines • Standardise the clinical examination • Apply education theory principles

10. Objectives • Knowledge - terminology, anatomy, pathology, associations, risk factors, examination, imaging • Change practice - improve clinical skills, confidence and referral procedures • Standardise approach - consistency across all health professionals

11. Learning Ability • Education level • Cultural background • Social class • Literacy skills • Trust in the information • Emotional state

12. information flow Challenge High ANXIETY BOREDOM Skill Low High

13. Learning Types • Visual • Auditory • Written • Kinesthetic

14. Pictures Words Sound

15. Developing the Module • Focus groups • Literature review • Educational objectives • Outcome measures • Script development • Story board • Animation • Testing

16. Testing the Module • Maternal and Child Health Nurses • Range of municipalities • 203 recruited

17. Information easy to understand

18. Recommend the use of the module

19. Module met educational needs

20. Knowledge

21. P< 0.001 P< 0.001

22. Confidence

23. p < 0.001

24. Change in Clinical Practice

29. What now? • Increase accessibility of module • online resource • roll out to other clinical groups • general practitioners • midwives • paediatricians • Update the module • response to feedback • Watch for changes • swaddling module developed

30. Swaddling • Recent trend for settling babies • What’s old is new again!! • High risk for DDH if not practiced safely

31. Navaho Indians

34. Has it made a difference? MOR at RCH (year to date)

35. Summary • This initiative is aimed at improving the health and well being of children by facilitating early diagnosis and referral of DDH • The module significantly improves the clinicians knowledge, skills and confidence in making the diagnosis • Aim to ultimately reduce the need for complex surgery due to late diagnosis

37. Take Home • Refresh your knowledge • Update your skills • Use the resources