With the roaring success of the BONE / BOTA Lost Tribe audit project (221 collaborators in 101 hospitals), BOTA is launched our 2nd national audit project, the Paediatric Orthopaedic Trauma Snapshot (POTS). POTS aims to identify what paediatric Orthopaedic trauma is treated surgically in the UK over the course of a week, and audit the surgical management of paediatric supracondylar fractures of the distal humerus.

 

Like the Lost Tribe project, the POTS audit project will also run on an equal equity basis. That means that if you participate in the project and submit data, you will be a named co-first author on any presentations and publications that inevitably result from such a large multi-centre study. Additionally, like The Lost Tribe audit project, we have made the data collection extremely simple.

 

The data collection is complete and we would like to thank all contributors to this project! The data is currently being analysed and we will keep you updated regarding this. Please collect your certificates through the link below.

Certificates available for collaborators


POTS Audit Toolkit:

 Intro Letter


The British Orthopaedic Trainees Association would like to invite you to participate in the BONE – BOTA National Summer Audit Project 2016, the POTS study.

Following on from the success of BOTA’s “Lost Tribe” audit, which was the largest Multi-centre trainee Led audit Project ever undertaken in the UK, with a total of 220 collaborators across 105 hospitals. This tried and tested method has been proven to reap huge benefits with minimal effort. All contributors received first author status through the BONE
collaborative network. Individualised data was provided to allow local presentation and all authors will reap the long-term benefits of presentation at national meetings, conferences and any subsequent journal publications.

The POTS study aims to highlight the variability in surgical management of paediatric trauma across the UK and its impact on delivery of care and training opportunities.

Trauma is the leading cause of death in the under 16s with over 24,000 cases reported over a 10 year period, with limb injuries accounting for 65%. Trauma care in the adult sector is well established and supported with over 40,000 pubmed articles. However, in comparison paediatric trauma care is relatively poorly reported and with the exception of
BOAST 11 there is currently little standardised guidance for management of paediatric injuries.

This study aims to evaluate the variation in surgical management of paediatric orthopaedic trauma, identify barriers to training opportunities and audit surgical management of supracondylar fractures across the UK against the BOAST 11 guidelines.

The audit will be a snapshot of all paediatric trauma cases that had surgery throughout the country for the period of 8am Wednesday 6th July to 8am Wednesday 13th July 2016.

We will collect data about the injury, surgery, referral source, grade of primary surgeon, and delay to surgery. For supracondylar fractures we will also collect data relating to the gold standard of the BOAST 11 guidelines. We will collect basic demographic details but no patient identifiable data.

We are trying to get collaborators in as many hospitals across the UK as possible, there is no limit as to the number of collaborators in each hospital. All collaborators that sign up will receive a ‘toolkit’ via email which explains the process of the study in more detail. As a collaborator for your hospital you are expected to register the audit with you local audit department and record details for all paediatric admissions that had surgery in your unit for the study week.

All collaborators who have submitted data will receive joint first authorship on any subsequent presentations and publications.

 

Many thanks,

The BOTA Committee

Frequently Asked Questions


 

Frequently Asked Questions

Who can be involved?

Anyone (including non-BOTA members and medical students) can be the named collaborator for a hospital and submit the data for that unit.

Why should I do this audit?

Because you get to be an equal first author of the largest multicentre trainee led audit ever performed in the UK with minimal effort on your part. It is also an easy way to tick off a requirement for ARCP. This data will be useful in highlighting some of the variation in how paediatric orthopaedic trauma is managed in the UK.

How do I become the named collaborator for my hospital?

By registering your interest on http://goo.gl/WylzJs, you will receive an email with the toolkit, downalod the spreadsheet and collect data within the study time period (08:00 06/7/2016 – 08:00 13/07/2016), and submit data spreadsheet to [email protected] by 20th July 2016 23:59.

How many people can be involved from one hospital?

There is no limit on how many people can be involved from each hospital. It is recommended that collaborators from the same trust work together to avoid unnecessary duplication of work.

Do I need permission from my hospital?

Yes, you will need to register the audit with your hospital’s audit department and ask one of your consultants to be the supervising consultant for the project. It is advisable to download your local trust audit registration form and populate it using information available in the toolkit.

When is data collection happening?

Data collection will happen between 08:00 Wednesday 6th July – 08:00 Wednesday 13th July. This is the study time period of interest for everyone across the UK.

What are we collecting data on?

We are collecting data on all paediatric orthopaedic trauma cases treated with surgery between 08:00 6th July and 08:00 13th July in the NHS. All patients 16 years or younger are included. Only patients that had surgery between the dates mentioned are included.

What happens if your hospital is purely for adult or elective Orthopaedics?

If your hospital does not treat any paediatric patients (patients under 16 years old) sustaining orthopaedic trauma, then you can still sign up and try to liaise with a colleague / friend to collect data at a neighbouring hospital.

How do I collect data?

The data collection spreadsheet is very simple to complete. Start by completing your details including which hospital you are collecting data for, and who are your co-collaborators (inc their email addresses). Each section corresponds to a 24-hour time period. Each row is for ONE patient only. There is enough room for 15 patients each day (it is not envisaged that your department will operate on more than 15 children per day. If you do, then please email [email protected]).

Do not record ANY patient identifiable data into the spreadsheet. Please complete each column for each patient and avoid leaving gaps in the data. Some cells are coded and will only allow you to submit data in a particular format (e.g. Date as DD/MM/YYYY). Most of the data can be collected from the operation notes and from PACS but please make sure that you have not missed any paediatric orthopaedic trauma cases that underwent surgery.

Data should be collected prospectively and spreadhseets should be emailed to [email protected] AFTER the data collection period has finished (08:00 on 13th July 2016) but before 20th July 2016 at 23:59.

Can I use the operation notes and PACS to collect the data?

Absolutely. This audit is designed to avoid having to chase patient notes. It is best to collect the data each day as you go along. Most of the information can be collected from the operation notes and from PACS. Any missing data may need to be collected from the electronic patient record / patient casenotes.

How do I record data on polytraumatised patients?

Please record each procedure as an individual row as if it is a new patient. For multiple procedures in the same patient done at the same operative sessions, please keep the operation date and time the same.

Should I record patients under the day they are admitted or the day they have surgery?
Please record the patients under the section of the spreadsheet corresponding to the date of surgery and not the date of admission. This means that some patients being operated on Wednesday 6th July were admitted before the study period and additionally, some patients admitted at the end of the study may not be recorded if they did not have surgery before 08:00 on Wednesday 13th July.

Should I record patients having surgery for non-trauma like a washout of a septic joint?

No, just record patients having surgery for paediatric orthopaedic trauma injuries (bony and soft tissue).

What if my trust has more than one site?

Complete a data collection spreadsheet for each hospital site and email them to [email protected] Make sure you put your FirstNameSurnameHospital.xls in the filename.

How do I record data?

Data should be recorded on the POTS Audit spreadsheet (found in the toolkit). This should submitted by emailing the completed spreadsheet to [email protected] no later than 20th July 2016 23:59

What if I am missing some data?

Please aim to obtain the missing data from the individuals before submitting the data for the whole department. Completeness of data is important to ensure we have a true representation of all surgically-treated paediatric Orthopaedic trauma cases in as many T&O departments in the UK as possible.

What happens if I sign up but don’t submit data?

You will not be recognized as an author or POTS collaborator. If there are any difficulties hindering your ability to submit data, please contact [email protected] and we will help you.

How do I get involved in writing up the project?

We will advertise for collaborators to get involved in the write up phase of the project after all the data has been collected and analysed. We welcome anyone who is interested to be involved in all aspects of this project. The idea is that it is equally owned by all collaborators. Everyone involved will have the data and slides sent to them so that they can present it locally after completion of the audit.

How does authorship work?

All publications from this work will name collaborators as equal first authors under the title “BONE collaborators” regardless of any individual’s extra input designing or writing up the project.

Rules of Engagement 


1. Each collaborator who submits data will be named as co-first author on any publications produced from the data collected. This means that people involved in the project design or write up are given preference in authorship.

2. More than one collaborator from a given hospital can submit data. It is preferable to work together with a colleague who is also signed up from your trust to avoid duplication.

3. Collaborators who fail to submit data within 7 days of the completion date for the audit (20th July 2016 23:59) will not be deemed as having successfully participated in the project and will not be included as an author. In essence, if you submit a completed data collection spreadsheet (sent to [email protected]), then you are recognised as a collaborator. If there are any problems with your data collection of any kind, please email [email protected] so that we can help you resolve any problems. The intention is to have everyone included in this widereaching trainee-organised national audit.

4. All collaborators are asked to register the POTS study with their local audit department after completing local audit registration forms and identifying a consultant to supervise the project.

5. All collaborators will be sent detailed information from the analysis of the data collected (locally, regionally, and nationally) so that they may be able to present it to their local trust if they wish.

Aims, Standards and Protocol 


POTS Protocol

1. To evaluate the variation in the surgical management of paediatric orthopaedic trauma in the NHS.

2. To audit the surgical treatment of paediatric supracondylar distal humerus fractures treated in the NHS.

Standards

BOA / BSCOS BOAST 11 Guideline:

Standards for practice audit:

  1. These injuries require early surgical treatment, ideally on the day of admission. However, night-time operating is not necessary unless there are indications for urgent surgery.
  2. Surgical stabilisation should be with bicortical wire fixation. Crossed wires are associated with a lower risk of loss of fracture reduction, whereas divergent lateral wires reduce the risk of injury to the ulnar nerve.
  3. 2mm diameter wires should be used, where possible, to achieve stability.

Methods

Collaborators in each participating trust will collect data prospectively using a locked, coded Excel spreadsheet. No patient identifiable data will be gathered. The data collection period is between 08.00am Wednesday 6th July to 08.00am Wednesday 13th July. All paediatric orthopaedic trauma cases requiring surgery between these dates will be included. Information on the patient’s age, gender, injury, operation, date/time of injury and surgery, and type of reduction will be recorded. For supracondylar distal humerus fracture, additional information on wire configuration, wire diameter, and number of wires used will be collected.

Analysis

For aim 1, hospital-by-hospital variation will be calculated for type of injuries treated, type of surgery performed, frequency, timing of surgery, and grade of primary surgeon. All statistical analysis will be conducted using SPSS.

For aim 2, % compliance to the BOAST 11 standards outlined in this document will be calculated for each hospital.

Individual hospital data in the context of national means will be presented in powerpoint format and circulated to all collaborators. All collaborators will be expected to ensure the trust data is presented at a local departmental audit meeting.