Hand Injury Audit

Objective: Hand injuries are one of the commonest limb injuries presented to the Emergency Department(ED). The structure and functions are intimately related such that any injury to the underlying structures could cause significant handicap that could be life altering. This audit seeks to explain areas for improvement
in practise and create more awareness of the Royal College of Emergency Medicine (RCEM) standards on hand injuries in the Emergency Department. The RCEM’s standards are documented documented mechanisms of injuries, evidence of analgesia given on presentation to the ED, hand dominance, the exclusion of tendon and nerve injury respectively on clinical examination of hand injuries.

Methods: 70 clinical notes of adult hand injuries presented to the ED between June and December 2014. The cases were randomly selected from the Symphony software(ED data software). There were no exclusion criteria, corresponding ED notes with hand injuries was collected and relevant data was recorded in a predesigned proforma according to the recommendation of the RCEM standards stated above. The data was collated and inputted into a spread sheet and then analysed using Microsoft Excel. The results were then analysed in line with RCEM Standards.

Results: 7% of the notes reviewed had evidence of analgesia given, 59 % documented hand dominance, and 79% documented to mechanism of injury while 81% tendon and nerve injury. 

Conclusion: There was a wide variation in the level of compliance with the RCEM standards for hand injuries with compliance being low in three of the five standards reviewed. There is thereby a need to create the awareness of RCEM guidelines on hand injuries and management amongst ED practitioners, to encourage ED
practitioners to document analgesia given in the ED or declined by patients.