{"id":7211,"date":"2020-06-23T00:00:00","date_gmt":"2020-06-23T00:00:00","guid":{"rendered":"https:\/\/prd-www.mccdn.io\/vitals\/?p=7211"},"modified":"2025-11-07T21:59:39","modified_gmt":"2025-11-07T21:59:39","slug":"mary-bridge-childrens-orthopedic-surgeons","status":"publish","type":"post","link":"https:\/\/updates-www.mccdn.io\/vitals\/mary-bridge-childrens-orthopedic-surgeons\/","title":{"rendered":"Mary Bridge Children\u2019s orthopedic surgeons and ED doctors partner for improved results","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"

Forearm fractures \u2014 broken arms \u2014 are among the most frequently encountered orthopedic injuries in children. In fact, more than 200 children are treated each year for these injuries at the Mary Bridge Children\u2019s Hospital Emergency Department (ED). When you think of the experts who fix broken bones, many people might think of orthopedic surgeons. But at Mary Bridge Children\u2019s, when a child comes in with a forearm fracture, it\u2019s the ED doctors that reduce and cast almost all of the forearm factures.<\/p>\n

Having an orthopedic surgeon available right away to treat an urgent injury like a broken arm can be challenging for many reasons. Having ED doctors who can expertly treat pediatric forearm fractures reduces delays in patient care and pain management.<\/p>\n

Around 25 years ago, two pediatric orthopedic surgeons on the Mary Bridge hospital staff at that time offered voluntary mentoring in fracture reduction and casting to all members of the ED doctors to help meet the orthopedic needs of the Emergency Departments and decrease the call burden on the orthopedists. Since then, the ED doctors have maintained an ongoing internal mentoring program with experienced ED doctors teaching each new ED member techniques of fracture reduction and casting.<\/p>\n

They\u2019ve been doing a very good job \u2014 but has it been good enough? To answer that question, Dr. Tom Hurt, MD, former Medical Director of the Mary Bridge Emergency Department; and Rebecca Whitesell, MD, pediatric orthopedic surgeon at Mary Bridge; decided to work together to determine just how well the ED doctors were doing, and if they could be doing better.<\/p>\n

The science and art of casting<\/h2>\n

Being able to cast properly is a skill that not every emergency doctor has. Training programs across the country are inconsistent in teaching this skill. Casting is both a science and an art. There are subtleties to casting \u2014 sometimes a cast needs to lean in slightly over the point of injury, so the bone does not slip back to a bad alignment. Though occasionally unavoidable, redoing a cast may mean having to redo the whole process \u2014 a trip to the operating room, anesthesia and rebreaking the bone. Not something any health care professional wants to subject a child and family to unnecessarily. So, it\u2019s important to try to get a cast right the first time.<\/p>\n

The pediatric ED doctors wanted to do all that they could to decrease the need for re-casting a broken arm.<\/p>\n

\u201cWe could align the fractures well \u2014 get the broken bones nicely lined up. And when we put the cast on, we did it in a way that we felt was correct,\u201d says Dr. Hurt. \u201cBut some of the time we recognized that the quality of our casting, the technique of our casting, was not as good as it should be. What we discovered was that after leaving the ED, even though the cast may have looked really good, a week or two after the injury, there were some cases where the alignment had slipped or angled. And that meant the setting and casting possibly had to be redone.\u201d<\/p><\/blockquote>\n

\u201cIt takes practice to make a cast that not only looks good, but also feels good and maintains the alignment of the bone,\u201d says Dr. Whitesell.<\/p>\n

Using data to improve care<\/h2>\n

The ED doctors\u2019 path to improvement began in 2015 and involved research, dedication and partnership.
\nThat year, Dr. Hurt, decided he wanted to look at the outcomes of fracture reduction and casting by the ED physicians at Mary Bridge to see if there was room for improvement. He started by doing a chart review of a year\u2019s worth of patients with broken forearms \u2014over 200 patients \u2014 in order to quantify the results.<\/p>\n

In collaboration with Dr. Whitesell, the data was presented to MultiCare\u2019s Institute for Research and Innovation. Bethann Pflugeisen, Research Scientist; and Jin Mou, MD, Senior Research Epidemiologist; carried out a complex statistical analysis of the results.<\/p>\n

\u201cThis project was a big win for all of us,\u201d Pflugeisen said. \u201cThis was a successful partnership between the Research Institute and people who are on the ground with patients. Through that partnership, we all learn from each other.\u201d<\/p><\/blockquote>\n

After analyzing the data, the research team knew exactly how many times a bone had slipped in a cast and a fracture had to be reset. It was determined, as anticipated, that there was room for improvement. The doctors concluded that they needed to make their casts snugger \u2013 but not too snug. The question was, \u201cHow could this be accomplished?\u201d<\/p>\n

\u201cWe had to find a sweet spot: it\u2019s a skill you learn with experience,\u201d Dr. Hurt says.<\/p>\n

A process improvement plan was developed. Over the following year, Drs. Hurt and Whitesell coached the ED doctors extensively, using x-rays of past treated fractures and hands-on practice with simulated bone models. Dr. Whitesell built the models herself and stole time from her one \u2018non-clinic day\u2019 each week to provide one-on-one coaching with the ED doctors.<\/p>\n

\u201cThe ED physicians did a great job at lining up the bone, but they weren\u2019t always aware of the pressure points to build into a cast. So, we talked about those,\u201d Dr. Whitesell says. \u201cI was so impressed that everyone wanted to learn. They seemed truly excited about learning from a subspecialist. It was so awesome to see this collaboration come together.\u201d<\/p>\n

At the end of the year-long coaching process, the research team collected data for another year. Results showed that forearm fracture outcomes had improved significantly, with the percentage of casts that held the bone in the right position for healing the first time increased from 81 to 91 percent, translating to roughly 20 children each year who would not have to come back to have a cast re-done or bones re-set. This is an exceptional accomplishment.<\/p>\n

Accolades and awards<\/h2>\n

In 2016, the team won the Best Ongoing Research award at the Research Institute\u2019s yearly competition and the following year won the Best Completed Research award.<\/p>\n

Then in 2019, the team\u2019s work was published in the June 19 issue of the Journal of Emergency Medicine as the article: \u201cDoes Mentoring by Orthopedic Surgeons Improve Forearm Fracture Reduction Outcomes by Pediatric Emergency Physicians? Evaluation of a Process Improvement Intervention Program<\/a>.\u201d<\/p>\n

Later that same year, the project was awarded MultiCare\u2019s President\u2019s Award for Excellence in Clinical Patient Outcomes & Quality.<\/p>\n

\u201cThe work Drs. Whitesell and Hurt did is both inspiring and valuable, says Dr. Mou. \u201cThis study benefits patients and is a good example for other hospitals.\u201d<\/p><\/blockquote>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"excerpt":{"rendered":"

Mary Bridge Children’s Hospital Emergency Department doctors and orthopedic surgeons work together to improve broken arm casting in the ED.<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"author":123,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[67,95],"tags":[],"class_list":["post-7211","post","type-post","status-publish","format-standard","hentry","category-kids-health","category-orthopedics"],"acf":[],"yoast_head":"\northopedic surgeons and ED doctors partner for improved results - MultiCare Vitals<\/title>\n<meta name=\"description\" content=\"When you think of the experts who fix broken bones, many people might think of orthopedic surgeons. 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