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Improving the Management of Tibia Stress Fractures: A Collaborative, Outpatient Clinic-Based Quality Improvement Project

Roberts, Cindy L.; Meyering, Christopher D.; Zychowicz, Michael E.

doi: 10.1097/NOR.0000000000000032
Original Articles

PURPOSE: Implement and evaluate the effectiveness of the Leg Pain Screening and Referral Tool (LPS&RT) for patients presenting with lower extremity leg pain in an outpatient clinic.

SAMPLE: A total of 46 patients diagnosed with tibia stress fractures.

METHODS: The study employed a pre-/postintervention design. Retrospective and prospective information was collected from an electronic health record to obtain patient data. The pre- and postintervention groups were compared on the number of patients diagnosed with tibia stress fractures. Provider adherence to the treatments recommended by the algorithm was assessed by chart audits postintervention.

RESULTS: There was a significant increase (87.5%) in tibia stress fracture diagnosis, from 16 preintervention to 30 postintervention. Provider adherence to the LPS&RT was 93.3% postintervention. Common treatments were activity restriction, oral medication, and/or specialty referrals.

CONCLUSION: The LPS&RT was an effective, uniform measure to standardize the plan of care for tibia stress fractures in one outpatient clinic.

Cindy L. Roberts, Major, DNP, RN, FNP-C, MBA, Clinical Research Nurse Practitioner, Department of Warrior Care, Martin Army Community Hospital, Fort Benning, GA.

Christopher D. Meyering, Lt. Colonel, DO, Director, Sports Medicine, Family Medicine Residency Program, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA.

Michael E. Zychowicz, DNP, RN, ANP, ONP, FAAN, FAANP, Director, MSN Program and Orthopaedic Program Lead Faculty, Duke University, Durham, NC.

The quality improvement project was reviewed and approved by the institutional review board at two independent facilities.

The author and planners have disclosed no potential conflicts of interest, financial or otherwise.

©2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.