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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 April 2009
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st April 2009 | 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 % | 53.3 % |
| X-ray post reduction | 100 % | 70 % | |||
| Two medical staff involved, one for reduction , one for sedation | 100 % | 50 % | |||
| Pain relief within 20 mins of arrival | 100 % | 26.6 % | |||
| Neurovascular examination (including axillary nerve) documented | 100 % | 66.6 % |
Comments
Mostly a disappointing set of results, with the exception of documentation of the numbers of staff involved in the reduction. Particularly poor is pain relief and the appropriate use of xrays.
Audit Bottom Line
Improvements required across the board, with particular attention paid to timeliness of pain relief.