A comparison of fracture reductions performed by physician extenders and orthopaedic residents in the acute pediatric orthopaedic practice

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: The Accreditation Council on Graduate Medical Education-mandated 80-hour work week has led many teaching hospitals to find adequate replacements for residents. In addition, the subspecialty of pediatric orthopaedics is currently experiencing a workforce shortage. At the authors' institution, Level I emergency department and hospital on-call duties alternate between orthopaedic residents and orthopaedic-specific nurse practitioners. There are no studies looking at the quality of care rendered in the pediatric orthopaedic setting by physician extenders. Methods: A consecutive series of 139 pediatric patients with the diagnosis of closed both-bones diaphyseal forearm fracture underwent closed reduction and casting by either a trained nurse practitioner or orthopaedic resident in the emergency department from July 2006 through June 2007. Fifty-seven (41%) patients were treated by a nurse practitioner and 82 (59%) patients were treated by an orthopaedic resident. All patients were followed to completion of treatment by fellowship-trained pediatric orthopaedic staff. Results: There was no significant difference between the two groups in regard to the use of conscious sedation, cast characteristics, fracture characteristics, or length of follow up (P > 0.05). Patients treated by orthopaedic residents required more minor interventions (48% versus 35%), but this was not statistically significant (P = 0.17). However, patients treated by orthopaedic residents had a higher rate of requiring premedication and molding of a new cast in clinic for loss of reduction (33% versus 18%), and this did approach statistical significance (P = 0.052). In addition, patients treated by orthopaedic residents had slightly more major interventions, which necessitated operative intervention to restore alignment of the fracture (11% versus 8%), but this did not reach statistical significance (P = 0.56). Conclusions: Pediatric patients with closed both-bones diaphyseal forearm fractures were treated successfully by both trained orthopaedic nurse practitioners and orthopaedic residents with no statistically significant difference in interventions.

Original languageEnglish (US)
Pages (from-to)244-249
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume24
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Physician Assistants
Fracture Fixation
Orthopedics
Pediatrics
Nurse Practitioners
Forearm
Hospital Emergency Service
Conscious Sedation
Graduate Medical Education
Bone and Bones
Premedication
Accreditation
Quality of Health Care
Teaching Hospitals

Keywords

  • Closed reduction
  • Forearm fracture
  • Nurse practitioners
  • Pediatric
  • Physician extender
  • Residents

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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title = "A comparison of fracture reductions performed by physician extenders and orthopaedic residents in the acute pediatric orthopaedic practice",
abstract = "Background: The Accreditation Council on Graduate Medical Education-mandated 80-hour work week has led many teaching hospitals to find adequate replacements for residents. In addition, the subspecialty of pediatric orthopaedics is currently experiencing a workforce shortage. At the authors' institution, Level I emergency department and hospital on-call duties alternate between orthopaedic residents and orthopaedic-specific nurse practitioners. There are no studies looking at the quality of care rendered in the pediatric orthopaedic setting by physician extenders. Methods: A consecutive series of 139 pediatric patients with the diagnosis of closed both-bones diaphyseal forearm fracture underwent closed reduction and casting by either a trained nurse practitioner or orthopaedic resident in the emergency department from July 2006 through June 2007. Fifty-seven (41{\%}) patients were treated by a nurse practitioner and 82 (59{\%}) patients were treated by an orthopaedic resident. All patients were followed to completion of treatment by fellowship-trained pediatric orthopaedic staff. Results: There was no significant difference between the two groups in regard to the use of conscious sedation, cast characteristics, fracture characteristics, or length of follow up (P > 0.05). Patients treated by orthopaedic residents required more minor interventions (48{\%} versus 35{\%}), but this was not statistically significant (P = 0.17). However, patients treated by orthopaedic residents had a higher rate of requiring premedication and molding of a new cast in clinic for loss of reduction (33{\%} versus 18{\%}), and this did approach statistical significance (P = 0.052). In addition, patients treated by orthopaedic residents had slightly more major interventions, which necessitated operative intervention to restore alignment of the fracture (11{\%} versus 8{\%}), but this did not reach statistical significance (P = 0.56). Conclusions: Pediatric patients with closed both-bones diaphyseal forearm fractures were treated successfully by both trained orthopaedic nurse practitioners and orthopaedic residents with no statistically significant difference in interventions.",
keywords = "Closed reduction, Forearm fracture, Nurse practitioners, Pediatric, Physician extender, Residents",
author = "Ho, {Christine A.} and Wilson, {Philip L.}",
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language = "English (US)",
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pages = "244--249",
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T1 - A comparison of fracture reductions performed by physician extenders and orthopaedic residents in the acute pediatric orthopaedic practice

AU - Ho, Christine A.

AU - Wilson, Philip L.

PY - 2010/4

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N2 - Background: The Accreditation Council on Graduate Medical Education-mandated 80-hour work week has led many teaching hospitals to find adequate replacements for residents. In addition, the subspecialty of pediatric orthopaedics is currently experiencing a workforce shortage. At the authors' institution, Level I emergency department and hospital on-call duties alternate between orthopaedic residents and orthopaedic-specific nurse practitioners. There are no studies looking at the quality of care rendered in the pediatric orthopaedic setting by physician extenders. Methods: A consecutive series of 139 pediatric patients with the diagnosis of closed both-bones diaphyseal forearm fracture underwent closed reduction and casting by either a trained nurse practitioner or orthopaedic resident in the emergency department from July 2006 through June 2007. Fifty-seven (41%) patients were treated by a nurse practitioner and 82 (59%) patients were treated by an orthopaedic resident. All patients were followed to completion of treatment by fellowship-trained pediatric orthopaedic staff. Results: There was no significant difference between the two groups in regard to the use of conscious sedation, cast characteristics, fracture characteristics, or length of follow up (P > 0.05). Patients treated by orthopaedic residents required more minor interventions (48% versus 35%), but this was not statistically significant (P = 0.17). However, patients treated by orthopaedic residents had a higher rate of requiring premedication and molding of a new cast in clinic for loss of reduction (33% versus 18%), and this did approach statistical significance (P = 0.052). In addition, patients treated by orthopaedic residents had slightly more major interventions, which necessitated operative intervention to restore alignment of the fracture (11% versus 8%), but this did not reach statistical significance (P = 0.56). Conclusions: Pediatric patients with closed both-bones diaphyseal forearm fractures were treated successfully by both trained orthopaedic nurse practitioners and orthopaedic residents with no statistically significant difference in interventions.

AB - Background: The Accreditation Council on Graduate Medical Education-mandated 80-hour work week has led many teaching hospitals to find adequate replacements for residents. In addition, the subspecialty of pediatric orthopaedics is currently experiencing a workforce shortage. At the authors' institution, Level I emergency department and hospital on-call duties alternate between orthopaedic residents and orthopaedic-specific nurse practitioners. There are no studies looking at the quality of care rendered in the pediatric orthopaedic setting by physician extenders. Methods: A consecutive series of 139 pediatric patients with the diagnosis of closed both-bones diaphyseal forearm fracture underwent closed reduction and casting by either a trained nurse practitioner or orthopaedic resident in the emergency department from July 2006 through June 2007. Fifty-seven (41%) patients were treated by a nurse practitioner and 82 (59%) patients were treated by an orthopaedic resident. All patients were followed to completion of treatment by fellowship-trained pediatric orthopaedic staff. Results: There was no significant difference between the two groups in regard to the use of conscious sedation, cast characteristics, fracture characteristics, or length of follow up (P > 0.05). Patients treated by orthopaedic residents required more minor interventions (48% versus 35%), but this was not statistically significant (P = 0.17). However, patients treated by orthopaedic residents had a higher rate of requiring premedication and molding of a new cast in clinic for loss of reduction (33% versus 18%), and this did approach statistical significance (P = 0.052). In addition, patients treated by orthopaedic residents had slightly more major interventions, which necessitated operative intervention to restore alignment of the fracture (11% versus 8%), but this did not reach statistical significance (P = 0.56). Conclusions: Pediatric patients with closed both-bones diaphyseal forearm fractures were treated successfully by both trained orthopaedic nurse practitioners and orthopaedic residents with no statistically significant difference in interventions.

KW - Closed reduction

KW - Forearm fracture

KW - Nurse practitioners

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KW - Physician extender

KW - Residents

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