31 Implementing a Bundle-of-Care approach to enhance timely interventions for displaced paediatric forearm fractures in the emergency department: A pre- and post-intervention study
Bibliographic record
Abstract
Abstract Background This study evaluated the effectiveness of a new bundle-of-care protocol for timely fracture management in children presenting to the emergency department (ED) with forearm fractures. Objectives The primary objective was to determine whether implementing a new bundle-of-care protocol in 2022 decreased the time from ED arrival to readiness for fracture reduction (termed “time to readiness”, defined as the completion of radiographs, analgesia administration, and intravenous (IV) insertion) compared to the pre-implementation period. Design/Methods This retrospective study analyzed data from children aged 1 to 17 years presenting to a tertiary paediatric ED with forearm fractures between April 2021 and September 2023. Included participants were patients requiring fracture reduction and triaged as CTAS 2 or triaged as CTAS 3 with pain severe enough to require opioids before imaging. The bundle-of-care, developed by a multidisciplinary team, included immediate transfer in the resuscitation room for IV insertion, analgesia, and radiographic imaging. Implementation used various knowledge translation methods, and iterative cycles identified barriers and facilitators. The primary outcome measured the time between ED arrival and readiness for fracture reduction. Secondary outcomes included time intervals between arrival and analgesia, IV access, radiographs, reduction and discharge from the ED. The analyses compared 95% confidence intervals (95%CI) for the difference in medians for these time intervals between pre- and post-implementation phases. Results During the study period, 247 children met the inclusion criteria, with a median age of 10 years old. Baseline demographics were similar in both pre- and post-implementation phases, but 182 were male (74%). Most children suffered from dual radius/ulna fractures (n=202). Median time to readiness decreased from 140 minutes to 103 minutes after implementing the bundle-of-care (difference: 32 minutes; 95%CI: 15-49 minutes). This decrease was also noted in median time to radiographs (difference: 16 minutes; 95%CI: 6-27 minutes), time to IV insertion (difference: 23 minutes; 95%CI 2-42 minutes), time to reduction (difference: 34 minutes; 95%CI: 15-55 minutes) and ED length of stay (difference: 40 minutes; 95%CI 16-67 minutes). However, no statistically significant difference was found for analgesia (difference: 3 minutes; 95%CI: -4 to 10 minutes). Conclusion We demonstrated that implementing a bundle-of-care protocol significantly reduced time to readiness for fracture reduction in paediatric patients. This was accompanied by improved time intervals in key steps of the protocol. These findings underscore the benefits of adopting structured care protocols to optimize treatment outcomes for paediatric fractures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".