scholarly journals LO065: Reduced length of stay and adverse events using Bier block for forearm fracture reduction in the pediatric emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S52-S53
Author(s):  
E. Fauteux-Lamarre ◽  
B. Burstein ◽  
A. Cheng ◽  
A. Bretholz
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Events ◽  
Forearm Fracture ◽  
Pediatric Emergency ◽  
Fracture Reduction ◽  
Pediatric Emergency Department ◽  
Forearm Fractures ◽  
Return Visits ◽  
Bier Block

Introduction: Distal forearm fractures are one of the most common injuries presenting to the pediatric emergency department. Procedural sedation (PS) is commonly used to provide analgesia during fracture reduction, but requires a prolonged recovery period and can be associated with adverse respiratory events. Bier block (BB) regional anesthesia is a safe alternative to PS for fracture reduction analgesia. We sought to assess the impact of BB on length of stay (LOS) and adverse events following forearm fracture reduction compared to PS. Methods: We performed a retrospective study of patients aged 6 to 18 years, presenting with forearm fractures requiring closed reduction from June 2012 to March 2014. The primary outcome measure was emergency department LOS; secondary outcomes included reduction success rates, adverse events and unscheduled return visits. Results: Two-hundred and seventy-four patients were included for analysis; 109 treated with BB, 165 underwent PS. Overall, mean LOS was 82 min shorter for patients treated in the BB group (279 min vs. 361 min, p<0.05). Sub-analysis revealed a reduced LOS among patients treated with BB for fractures involving a single bone (286 min vs. 388 min, p<0.001) and both-bones of the forearm (259 min vs. 321 min, p<0.05). Both BB and PS resulted in comparable rates of successful reduction (98.2% vs. 97.6%, p=0.74). There were no major adverse events in either group. Patients who received BB experienced significantly fewer minor adverse events (2.7% vs. 14.5%, p<0.05). Return visit rates were similar in the BB and PS groups (17.6% vs. 17.1%, p<0.05). Conclusion: Compared to PS, forearm fracture reduction performed with BB was associated with a reduced emergency department LOS and fewer adverse events, with no difference in reduction success or return visits.

Reduced Length of Stay and Adverse Events Using Bier Block for Forearm Fracture Reduction in the Pediatric Emergency Department

2019 ◽  
Vol 35 (1) ◽  
pp. 58-62 ◽  
Author(s):  
Emmanuelle Fauteux-Lamarre ◽  
Brett Burstein ◽  
Adam Cheng ◽  
Adam Bretholz
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Events ◽  
Forearm Fracture ◽  
Pediatric Emergency ◽  
Fracture Reduction ◽  
Pediatric Emergency Department ◽  
Bier Block

scholarly journals Simulation and Web-based learning increases utilization of Bier block for forearm fracture reduction in the pediatric emergency department

CJEM ◽  
2016 ◽  
Vol 19 (06) ◽  
pp. 434-440 ◽  
Author(s):  
Brett Burstein ◽  
Emmanuelle Fauteux-Lamarre ◽  
Adam Cheng ◽  
Dominic Chalut ◽  
Adam Bretholz
Keyword(s):  
Emergency Department ◽  
Forearm Fracture ◽  
Pediatric Emergency ◽  
Fracture Reduction ◽  
Pediatric Emergency Department ◽  
Clinical Use ◽  
Web Based ◽  
Training Course ◽  
Willingness To Use ◽  
Bier Block

Abstract Objectives Bier block (BB) is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet remains infrequently used in the pediatric emergency department (PED). No standardized methods of BB training have previously been described. The objective of this study was to determine whether a multimodal instructional course increases comfort with BB and translates to increased use of this technique. Methods A novel interdisciplinary simulation and Web-based training course was developed to teach the use of BB for forearm fracture reduction at a tertiary PED. Participants were surveyed pre-/post-training, and at 2 and 6 months regarding their comfort with BB. In parallel, we prospectively assessed the clinical use of BB for children ages 6 to 18 years requiring closed reduction of forearm fractures during the 24-month post-course period. Results Course participation included 26 physicians and 12 nurses. Survey response rate was 100%. Course participation increased both comfort (10% pre-training v. 89% post-training, p&lt;0.001) and the willingness to use BB (51% pre-training v. 95% post-training, p&lt;0.001), an effect sustained at 6 months post-course (66% and 92%, respectively, p&lt;0.001 for both). In clinical practice, there were no BBs performed prior to course administration. We observed a consistent and sustained increase in clinical use among the BB-trained physicians, with 37% of all forearm reductions performed using BB at 24 months post-course completion. Conclusions A novel combined simulation and Web-based training course increased comfort and willingness to use BB and was associated with increased use of this technique for forearm fracture reduction in the PED.

Language and Length of Stay in the Pediatric Emergency Department

2006 ◽  
Vol 22 (9) ◽  
pp. 640-643 ◽  
Author(s):  
Ran D. Goldman ◽  
Parsa Amin ◽  
Alison Macpherson
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

scholarly journals Factors Affecting Family Presence During Fracture Reduction in the Pediatric Emergency Department

2018 ◽  
Vol 19 (6) ◽  
pp. 970-976 ◽  
Author(s):  
Albert Zhang ◽  
Regina Yocum ◽  
Michael Repplinger ◽  
Aimee Broman ◽  
Michael Kim
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Fracture Reduction ◽  
Pediatric Emergency Department ◽  
Family Presence ◽  
Factors Affecting

scholarly journals P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83 ◽  
Author(s):  
F. Al-Sani ◽  
M. Ben-Yakov ◽  
G. Harvey ◽  
J. Gantz ◽  
D. Jacobson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Ankle Injuries ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
X Ray ◽  
Return Visits ◽  
Unnecessary Testing

Introduction: Our tertiary care institution embarked on the Choosing Wisely campaign to reduce unnecessary testing, and selected the reduction of ankle x-rays as part of its top five priority initiatives. The Low Risk Ankle Rule (LRAR), an evidence-based decision rule, has been derived and validated to clinically evaluate ankle injuries which do not require radiography. The LRAR, is cost-effective, has 100% sensitivity for clinically important ankle injuries and reduces ankle imaging rates by 30-60% in both academic and community setting. Our objective was to significantly reduce the proportion of ankle x-rays ordered for acute ankle injuries presenting to our pediatric Emergency Department (ED). Methods: Medical records were reviewed for all patients presenting to our tertiary care pediatric ED (ages 3- 18 years) with an isolated acute ankle injury from Jan 1, 2016-Sept 30, 2016. Children with outside imaging, an injury that occurred &gt;72 hours prior, or those who had a repeat ED visit for same injury were excluded. Quality improvement (QI) initiatives included multidisciplinary staff education about the LRAR, posters placed within the ED highlighting the LRAR, development of a new diagnostic imaging requisition for ankle x-rays requiring use of the LRAR and collaboration with the Division of Radiology to ensure compliance with new requisition. The proportion of patients presenting to the ED with acute ankle injuries who received x-rays was measured. ED length of stay (LOS), return visits to the ED and orthopedic referrals were collected as balancing measures. Results: At baseline 88% of patients with acute ankle injuries received x-rays. Following our multiple interventions, the proportion of x-rays decreased significantly to 54%, (p&lt;0.001). This decrease in x-ray rate was not associated with an increase in ED LOS, ED return visits or orthopedic referrals. There was an increase uptake of the dedicated x-ray requisition over time to 71%. Conclusion: This QI initiative to increase uptake of the LRAR, resulted in a significant reduction of ankle x-rays rates for children presenting with acute ankle injuries in our pediatric ED without increasing LOS, return visits or need for orthopedic referrals for missed injuries. Just as in the derivation and validation studies, the reductions have been sustained and reduced unnecessary testing and ionizing radiation.

scholarly journals Characteristics of patients and families who make early return visits to the pediatric emergency department

2013 ◽  
pp. 9 ◽  
Author(s):  
Samina Ali ◽  
Logue ◽  
Spiers ◽  
Newton ◽  
Lander
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Early Return ◽  
Return Visits

Ketamine-Propofol Combination Sedation for Fracture Reduction in the Pediatric Emergency Department

2007 ◽  
Vol 23 (12) ◽  
pp. 881-884 ◽  
Author(s):  
Ghazala Q. Sharieff ◽  
Douglas R. Trocinski ◽  
John T. Kanegaye ◽  
Brock Fisher ◽  
Jim R. Harley
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Fracture Reduction ◽  
Pediatric Emergency Department
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