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The Duke Orthopaedic Journal


Introduction: Variation in practice among resident physicians is a barrier to providing consistent, high-quality care to patients with musculoskeletal injuries.

Materials and methods: A multidisciplinary group at an academic center developed a checklist for managing suspected extremity injuries in adults. Simulation testing was conducted in which 17 Emergency Medicine residents were randomized by year of training into cohorts of 8 “checklist” residents and 9 “no checklist” residents. Each resident performed 2 case simulations and was evaluated based on adherence to 12 predefined critical process measures.

Results: Usage of the checklist resulted in a decrease in delay of care events (8.3 vs 27.3%, p < 0.01) and decrease in potential medical errors (5.7 vs 22.2%, p < 0.01). All levels of training demonstrated improvements, and first-year residents using the checklist performed significantly better than thirdyear residents without the checklist, demonstrating decrease in delay of care events (8.3 vs 26.4%, p < 0.05) and decrease in potential medical errors (5.6 vs 18.1%, p < 0.05).

Conclusion: Implementation of a simple checklist can reduce delays in care and potential medical errors in the management of extremity injuries by resident physicians.

Keywords: Checklist, Cost, Education, Efficiency, Emergency medicine, Extremity, Fracture, Injury, Orthopaedics, Quality, Throughput, Value.

How to cite this article:Hamid KS, Nwachukwu BU, Nicks BA, Dutta S, Carroll EA. Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency through a Simple Checklist? The Duke Orthop J 2016;6(1):7-11.

Source of support: Nil

Conflict of interest: None.

IRB statement: This simulation was undertaken as part of an institutional quality improvement project and was granted Institutional Review Board exemption.

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