We present a complete audit cycle of Emergency Department management of paediatric clavicle fractures at Derriford Hospital. Local guidelines divide the clavicle into three zones. Fractures with minimal displacement in the middle 3/5th heal in the majority of cases without complication and can be discharged without need for follow up, provided parents are adequately educated. An initial audit cycle of 63 cases identified short comings in adherence to the guidelines. These included: Unnecessary fracture clinic follow up of ‘Zone 2’ fractures in 85% and omission of written advice in 86%. The results were circulated, ‘aide memoir’ icons were added to the department's computer coding system, staff teaching sessions were organised and a patient advice sheet was produced. Following the implementation of changes, a 23 case re-audit showed fewer unnecessary referrals to fracture clinic (17% vs. 85%) and improvements in the number of parents being given written advice (43% vs. 14%). Staff training, provision of information leaflets and changes to the ED coding system dramatically improved the adherence to hospital guidance. This resulted in standardisation of care, fewer unnecessary appointments and cost savings to the trust. Following this audit, a telephone survey was completed to assess parent's satisfaction with their treatment.
