Enhancing Neurovascular Assessment Documentation in Paediatric Supracondylar Fractures: A Closed Loop Audit.

Background and objective Paediatric supracondylar fractures of the humerus are associated with significant neurovascular complications that can result in devastating long-term consequences if not properly assessed and documented. The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASts) guidelines emphasise the critical importance of comprehensive neurovascular assessment in these patients. This closed-loop audit aimed to evaluate and improve compliance with BOASts guidelines for preoperative neurovascular documentation in paediatric supracondylar fractures at a District General Hospital in the United Kingdom. Methods A retrospective closed-loop audit was conducted over two cycles. The first cycle (January-September 2022) included 24 patients under 15 years with supracondylar fractures. Following implementation of targeted interventions, including staff education and introduction of standardised neurovascular assessment proformas, a second cycle (October 2022-June 2023) was conducted with 34 patients. Data were collected from electronic databases and analysed using Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results Compliance with the BOASts guidelines improved significantly from 45.8% (11/24 patients) in the first cycle to 76.5% (26/34 patients) in the second cycle (p = 0.017). Preoperative neurovascular compromise was identified in 12.5% (3/24) of patients in cycle one and 14.7% (5/34) in cycle two, with all cases resolving postoperatively. One patient in each cycle experienced postoperative neurovascular complications, both of which were successfully managed. Conclusion Implementation of targeted educational interventions and standardised documentation tools significantly improved compliance with the BOASts guidelines for neurovascular assessment in paediatric supracondylar fractures. This audit demonstrates the effectiveness of systematic quality improvement initiatives in enhancing patient safety and clinical documentation standards.