Development of electronic software for the management of trauma patients on the orthopaedic unit.

INTRODUCTION: Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management. METHODS: Data was prospectively collected and analyzed using the SPSS 14 statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software. RESULTS: With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% (p<0.0001) and missing patient location from 18.6% to 3.6% (p<0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% (p<0.0001) and from 11.7% to 0.8% (p<0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% (p<0.0001) and from 13.7% to 1.1% (p<0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was 'closed' or 'open', whereas in the electronic group this information was evident in all 357 patients (p<0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% (p<0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software. CONCLUSIONS: The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.

Failure of a "screw-in" acetabular component: ten-year results, survivorship analysis, and the prediction of failure.

The Rotalok screw-in threaded acetabular component was prospectively reviewed with 10-year clinical and radiological follow-up for 60 patients. Nine patients died and 5 were lost to follow-up. Clinically, 28 patients were pain-free, 13 had mild pain, and 3 had moderate pain. Thirteen patients underwent revision for loosening and 3 required revision but were unfit. Superior migration, angular migration, and zone lucency were measured radiologically. Cumulative survival was 70.75% with revision surgery as the end point and 60% with combined clinical failure and revision as the end point. Angular migration of 3 degrees or more was a significant predictor of clinical failure and revision (P < .0001), with 5 degrees being very highly predictive with a sensitivity of 0.72 and a specificity of 1.00. Revision was associated with younger patients (P = .03) and autograft use without screw stabilization (P = .024). The high failure rate of the Rotalok necessitates careful clinical and radiological follow-up, with asymptomatic radiological angular migration often the first predictor of failure.