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Shoulder Dislocation CPI
Clinical scenario
Dislocated shoulders are a common problem faced by emergency physicians. For patients they are often extremely painful injuries that they consequently require prompt attention if they are to be managed well. The vast majority >95%) of dislocations are anterior dislocations.
Audit question
Are shoulder dislocations managed appropriately according to best practice guidelines?
Method
Retrospective audit
Sample: 30-50 Emergency Department patient records
Criteria
Inclusions: All shoulder dislocations in patients aged 16 or over
Exclusions: Dislocations associated with greater tuberosity fractures, humeral and/or clavicular fractures, and children
Audits
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1st December 2007
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2007 | Patients aged 16 or over presenting to the ED with shoulder dislocations Exclusions: Dislocations associated with greater tuberosity fractures, humeral and/or clavicular fractures, and children | Management of patients according to the criteria. | X ray taken within 60 mins of arrival | 100 % | 48 % |
| X-ray post reduction | 100 % | 97 % | |||
| Two medical staff involved, one for reduction , one for sedation | 100 % | 46 % | |||
| Pain relief within 20 mins of arrival | 100 % | 18 % | |||
| Neurovascular examination (including axillary nerve) documented | 100 % | 90 % |
Comments
Mixed set of results overall. Slight improvement noted in x-ray post reduction, and significant improvement in documentation of neuro exam. However, significant decline in timeliness of x-ray, no. of medical staff involved in reduction, and timeliness of pain relief, all of which were areas requiring significant improvement following the last audit.
Audit Bottom Line
Disappointing set of results overall, although imaging satisfactory but large scope for improvement of pain management, staffing levels and post-reduction examination.