Lafreniere Ann-Sophie, Baykan Altay, Hartley Rebecca, Ronksley Paul, Love Shannan, Harrop Alan Robertson, Fraulin Frankie O G, Campbell Dave J T, Donald Maoliosa
University of Calgary, Calgary, Alberta, Canada.
Plast Reconstr Surg Glob Open. 2023 Feb 17;11(2):e4815. doi: 10.1097/GOX.0000000000004815. eCollection 2023 Feb.
Pediatric hand fractures are common, and many are referred to hand surgeons despite less than 10% of referrals requiring surgical intervention. We explored healthcare provider and parent perspectives to inform a new care pathway.
We conducted a qualitative descriptive study using virtual focus groups. Emergency physicians, hand therapists, plastic surgeons, and parents of children treated for hand fractures were asked to discuss their experiences with existing care for pediatric hand fractures, and perceptions surrounding the implementation of a new care pathway. Data were analyzed using directed content analysis with an inductive approach.
Four focus groups included 24 participants: 18 healthcare providers and six parents. Four themes were identified: educating parents throughout the hand fracture journey, streamlining the referral process for simple hand fractures, identifying the most appropriate care provider for simple hand fractures, and maintaining strong multidisciplinary connections to facilitate care. Participants described gaps in the current care, including a need to better inform parents, and elucidated the motivations behind emergency medicine physicians' existing referral practices. Participants also generally agreed on the need for more efficient management of simple hand fractures that do not require surgical care. Healthcare providers believed the strong preexisting relationship between surgeons and hand therapists would facilitate the changes brought forward by the new care pathway.
These findings highlighted shortcomings of existing care for pediatric hand fractures and will inform the co-development and implementation of a new care pathway to enable more efficient management while preserving good patient outcomes.
小儿手部骨折很常见，尽管转诊病例中不到10% 需要手术干预，但仍有许多被转诊至手外科医生处。我们探讨了医疗服务提供者和家长的观点，以为新的护理路径提供参考。
我们使用虚拟焦点小组进行了一项定性描述性研究。邀请了急诊医生、手部治疗师、整形外科医生以及手部骨折患儿的家长，讨论他们在小儿手部骨折现有护理方面的经验，以及对新护理路径实施的看法。采用归纳法进行定向内容分析来分析数据。
四个焦点小组共有24名参与者：18名医疗服务提供者和6名家长。确定了四个主题：在手部骨折治疗全程对家长进行教育、简化简单手部骨折的转诊流程、确定简单手部骨折最合适的护理提供者，以及保持紧密的多学科联系以促进护理。参与者描述了当前护理中的差距，包括需要更好地告知家长，并阐明了急诊医学医生现有转诊做法背后的动机。参与者普遍还认为，需要对不需要手术治疗的简单手部骨折进行更有效的管理。医疗服务提供者认为，外科医生和手部治疗师之间预先存在的紧密关系将促进新护理路径带来的变革。
这些发现突出了小儿手部骨折现有护理的不足，并将为新护理路径的共同开发和实施提供参考，以实现更高效的管理，同时保持良好的患者治疗效果。
