Question & methods: Whether quality improvement interventions could decrease the rate of repeat reductions in pediatric hand injuries by plastic surgeons. The study was conducted using two Plan-Do-Study-Act cycles that implemented informal feedback and formal educational workshops for ED physicians. This was examined over a 5-year period.
Finding: There was a decrease in rates of repeat reductions by plastic surgeons from 8.7% to 3% following implementation of quality improvement interventions.
Limitations: Single-center study with a small sample size. Identification of patients and need for repeat reduction are based on clinician judgement and may vary between providers. Methodology is unclear making it challenging to reproduce this study (e.g., Lack of information and observation period, poorly defined PDSA cycles making it difficult to tease out what may have contributed to improvement).
Interpretation: This quality gap likely exists even if this topic is quite niche to the pediatric world, the paper demonstrates that a multifaceted approach does show improvement. Unfortunately, the interventions are too vaguely described to be able to replicate. Furthermore, it would be hard to tease out which components provide the most impact since they were introduced as a bundle.
JC Supervisor: Dr. Krishan Yadav