566 Improving Neurovascular Status Assessment and Documentation in the Emergency Department: A Closed-Loop Audit

Aim

To improve neurovascular status assessment and documentation in the Emergency Department.

Method

Clinical notes were reviewed for 55 consecutive patients presenting with extremity fractures during February and March 2022. Neurovascular (NV) assessment and documentation was reviewed at presentation and after any intervention to the limb. Semi-structured interviews were conducted with Emergency Department staff, to identify barriers to NV assessment and documentation. Changes were implemented and the audit cycle repeated in October 2022 for 56 consecutive patients.

Results

The main barriers to NV assessment and documentation were forgetfulness, lack of awareness of requirement to document NVS pre- and post-intervention, poor quality induction given to clinicians of the importance of documenting NVS and lack of awareness of track commands. Three changes were therefore implemented: a video on NV assessment for new starters; a teaching session for current staff; a ‘shortcut’ for typing the NV assessment in the electronic patient record.

Improvements were made in all domains; documentation of NVS for ankle fractures pre-manipulation increased from 73% to 96%, and from 31% to 46% for post-manipulation between loop 1 and 2. Documentation of NVS for wrist fractures pre-manipulation increased from 93% to 96%, and from 14% to 36% for documentation post-manipulation. Improvement was most noticeable in the documentation of individually named nerves, increasing by 16.4% (p<0.05).

Conclusions

Semi-structured interviews were helpful in illuminating areas for improvement. Importantly, these were sustained for over 6 months. A third cycle is in progress, where further incremental gains are sought.