| Description |
Background: Vertebral compression fractures (VCFs) are a significant health concern. They are often undiagnosed or mismanaged, leading to chronic pain, immobility, and increased healthcare costs. At the clinical site, management of VCF neglected standardized treatment or follow-up care processes, contributing to inconsistent diagnosis and management. This quality improvement (QI) project aimed to develop and implement an evidence-based practice (EBP) VCF treatment toolkit to improve provider adherence, standardize care, and enhance patient outcomes. Local Problem: The project occurred at a Level II trauma center emergency department, resource trauma hospital emergency department (ED), and two freestanding EDs in Utah. Providers reported inconsistencies in diagnosing and managing VCFs, leading to inconsistencies in care. The lack of standardized protocols and workflow integration resulted in missed diagnoses, treatment delays, and care inconsistencies. Methods: The EBP VCF toolkit was carried out in four phases. Phase 1 involved distributing a preimplementation survey to 39 ED providers to assess current practices, barriers, and knowledge gaps. Phase 2 focused on developing an EBP VCF treatment toolkit, including a clinical algorithm, SmartPhrase for electronic health record (EHR) integration, educational modules, and follow-up coordination protocols. In Phase 3, the toolkit was implemented over a six-week period using weekly Plan-Do-Study-Act (PDSA) cycles, with ongoing provider feedback and workflow adjustments. In Phase 4, a post-implementation survey and qualitative interviews were conducted to evaluate the toolkit's feasibility, usability, and satisfaction, with findings to guide future refinement and sustainability. Interventions: The VCF treatment toolkit was introduced via staff meetings and Zoom-based educational sessions, with 69.2% of providers attending. The goal was to simplify clinical workflows by making identifying VCFs easier, ensuring proper imaging, standardizing treatment, and improving follow-up care. Providers were also encouraged to use the SmartPhrase tool in the EHR to keep documentation consistent, streamline care, and assess adherence to the toolkit. Results: After the six-week implementation period, a post-survey (35.89% response rate) and qualitative interviews assessed the feasibility, usability, and satisfaction of the VCF treatment toolkit. One hundred percent of respondents found the toolkit feasible, with 100% adherence to brace recommendations at follow-up. Providers rated the toolkit highly usable, improving clinical decision-making and workflow standardization. However, SmartPhrase utilization remained at 50%, indicating workflow barriers. Communication between ED providers, specialty clinics, and bracing companies improved care coordination and patient education. Challenges included low survey response rates, inconsistent SmartPhrase usage, and time constraints impacting adoption. Despite these challenges, provider satisfaction was high, supporting the toolkit's value and illustrating the need for further refinement to increase engagement and streamline SmartPhrase usage. |
