149 Improving Compliance with BOAST Guidance for Medical Photography of Open Fractures
H Imran, R EspeyAbstract
Aim
The British Orthopaedic Association Standards for Trauma (BOAST) guidance recommends that photographs of open fractures be taken at key stages of management — upon initial exposure, before debridement, and at other critical points — and stored in the patient’s medical records. This project aimed to improve compliance with the BOAST standard at the Royal Victoria Hospital (RVH) by ensuring open fractures are photographed and images uploaded to the hospital's photo upload software.
Method
A two-cycle quality improvement project was conducted:Cycle 1 (Pre-Intervention): Compliance was assessed in 15 consecutive open fracture cases between January 27–March 7, 2024.Cycle 2 (Post-Intervention): Compliance was reassessed in 15 consecutive cases from April 22–May 22, 2024, after introducing photo upload software access for Trauma and Orthopaedics (T&O) doctors and an awareness campaign.Fracture types included femur, tibia/fibula, ankle, forearm, wrist, and midfoot injuries.
Results
Compliance improved significantly, from 7% in Cycle 1 to 93% in Cycle 2. The intervention also expanded the use of medical photography to document skin abrasions, lacerations, and blisters, improving overall wound care practices.
Conclusions
Providing access to photo upload software and increasing awareness significantly improved compliance with BOAST standards for open fractures at RVH. The intervention demonstrated the importance of education and system access in driving quality improvement. Future steps include expanding photo-upload awareness to other specialties and addressing data protection concerns, including developing informed consent protocols and enhancing security measures.