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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 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2008 | 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 the patients according to the criteria | X ray taken within 60 mins of arrival | 100 % | 60 % |
| X-ray post reduction | 100 % | 100 % | |||
| Two medical staff involved, one for reduction , one for sedation | 100 % | 20 % | |||
| Pain relief within 20 mins of arrival | 100 % | 52 % | |||
| Neurovascular examination (including axillary nerve) documented | 100 % | 80 % |
Comments
Mixed set of results overall. Improvement noted in x-ray post reduction, and slight improvement in timeliness of pain relief. However, decline in timeliness of x-ray, number of medical staff involved in reduction, and documentation of neurovascular examination.
Audit Bottom Line
Disappointing set of results overall, although imaging satisfactory but large scope for improvement of pain management, staffing levels and neurovascular exam.