ABSTRACT
Background Orthopaedic ankle fractures are common injuries that require careful assessment, management, and documentation to ensure optimal patient outcomes. Proper documentation plays a critical role in facilitating communication among healthcare professionals, ensuring accurate diagnosis, treatment planning, and monitoring patient progress. Moreover, it is essential for medico-legal purposes and quality improvement initiatives. This article presents a comprehensive clinical audit aimed at evaluating the quality of orthopaedic ankle fracture documentation within a healthcare setting. The aim of this project was to assess the quality and accuracy of ankle fracture documentation within a single centre against the audit standards set by the British Orthopaedic Association (BOA) and the National Institute for Health and Care Excellence (NICE). Methods The study was a closed-loop audit utilising both retrospective and prospective analysis of ankle fracture clerking documentation performed by members of the trauma and orthopaedics team. Two audit cycles were completed in total; the first cycle was carried out in January 2020 where data were collected retrospectively from all orthopaedic admissions of ankle fractures. This was then re-audited against the BOA and NICE guidelines and presented to the local clinical governance meeting. A targeted educational intervention was then implemented with the goal of educating and reinforcing to key team members the documentation standards and the importance of accurate clerking documentation. The second cycle was carried out during July 2020 prospectively. All data were collected and collated with a total of nine data parameters analysed. Patients were included if they were skeletally mature and presented with closed malleolar and syndesmotic ankle injuries. Excluded patients were those who presented with open fractures, pilon fractures, and/or were skeletally immature. Data were then re-presented at the clinical governance meeting. Results A total of 23 patients were identified in the initial audit cycle and 22 patients in re-audit. On admission, it was found that 86% of patients presenting with ankle fractures had adequate documentation of their injury mechanism, which subsequently improved to 100% following the intervention. Similarly, there was a 71% improvement in precise documentation of clinical findings of ankle fractures. There was a marked improvement in the consistency of examination findings as well, with over 30% improvement in the rate of documentation for sensation status, skin integrity, circulation, and motor function. Results also revealed a 71% improvement in the documentation rates of vascular examinations where a Doppler ultrasound was used or pulses named in the documentation. Conclusion Through a targeted educational scheme focussing on the proposed documentation guidelines, we noted a significant improvement in documentation standards and accuracy of ankle fractures in the trauma and orthopaedic department. With ongoing educational input and reinforcement, team members can be supported to maintain a high level of documentation that meets all available standards, which will ultimately lead to improved patient care.
ABSTRACT
BACKGROUND: Peer-assisted learning (PAL) and mock examinations have been credited as effective teaching tools; however, there is a lack of research into their effectiveness in PACES (practical assessment of clinical examination skills). This study demonstrates an effective model and the benefits of PAL after its implementation in a mock PACES at Imperial College London. There is a lack of research into the effectiveness of PAL and mock examinations in PACES METHODS: A mock PACES was designed for fifth-year medical students. Examiners were recruited from the final year and from the foundation year doctor (intern) cohort. A Likert scale (1, strongly disagree; 5, strongly agree) questionnaire given before and after the exam was used to investigate its effectiveness. RESULTS: A total of 41 pre-mock exam surveys (57% completion rate) and 57 post-mock exam surveys (79% completion rate) were completed. Students felt significantly more confident after the mock PACES (mean 3.54 post-mock exam versus 2.68 pre-mock exam), with 90.64 per cent of students agreeing that this mock PACES was more useful than a lecture-based format, bedside teaching and small group teaching in order to prepare for this exam. Twenty-eight tutor surveys were completed (87.5% completion rate). Tutors agreed that the mock PACES had improved their confidence in their teaching ability (mean 4.07) and enhanced their clinical knowledge (mean 4.18). DISCUSSION: The mock PACES demonstrated benefits to confidence levels and knowledge both for tutees and tutors. The results demonstrate an effective model in examination preparation for PACES. This reinforces the holistic positive attributes gained from the use of PAL and mock examinations, whilst encouraging its use within the undergraduate syllabus.
