title: An Educational Intervention to Improve Splinting of Common Hand Injuries.
abstract: BACKGROUND
  Hand trauma is a top presenting complaint to hospital emergency departments (EDs) and can become costly if not treated effectively. The cornerstone for initial management of the traumatized hand is application of a splint. Improving splinting practice could potentially produce tangible benefits in terms of quality of care and costs to society.
  
  
  OBJECTIVE
  We sought to determine the following: 1) whether the present standard of ED splinting was appropriate and 2) whether a strategically planned educational intervention could improve the existing care.
  
  
  METHODS
  We used a pre- and postprospective educational intervention study design. In the preintervention phase, patients referred to our hand clinic were assessed for injury and splint type. Splinting appropriateness was evaluated according to a predetermined hand surgeons' expert consensus. Next, an educational intervention was targeted at all ED staff at our institution. Postintervention, all patients were again evaluated for splint appropriateness. A follow-up evaluation was performed at 1 year to see the long-term effects of the intervention.
  
  
  RESULTS
  The most common mechanism of injury of referred patients was falling (35%), and the most frequent injury was metacarpal fracture (40%). Splint appropriateness increased significantly postintervention from 49% to 69% (p = 0.048). At follow-up after 1 year, splinting appropriateness was 70% (p = 0.041).
  
  
  CONCLUSIONS
  Appropriate hand splinting practice is essential for hand trauma management. Our results show that an educational intervention can successfully improve splinting practice. This quality of care initiative was low-cost and demonstrated persistence at 1 year of follow-up.
authors.affiliation: University of Toronto Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: McEvenue
authors.affiliation: University of Toronto Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: FitzPatrick
authors.affiliation: University of Toronto Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Herbert P
authors.initials: HP
authors.lastname: von Schroeder
mesh_terms: D000328:Adult; D004635:Emergency Medicine / Q000193:education* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D007318:Inservice Training; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D013165:Splints / Q000592:standards*; D013997:Time Factors; D055815:Young Adult
keywords: education; hand; intervention; splinting; trauma