title: The Nasal Fracture Algorithm: A Case for Protocol-Driven Management to Optimize Care and Resident Work Hours.
abstract: Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lanigan
authors.affiliation: 2 Portia Statistical Consulting LLC, San Antonio, Texas, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Lospinoso
authors.affiliation: 3 Department of Otology and Laryngology, Division of Pediatric Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Bowe
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Laury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D009295:Nasal Bone / Q000293:injuries*; D010036:Otolaryngology / Q000193:education*; D010561:Personnel Staffing and Scheduling; D016526:Workload
keywords: duty hour restrictions; graduate medical education; military medicine; nasal bone fracture; otolaryngology; residency