Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.

<h4>Introduction</h4>Femoral head collapse (FHC) is a rarely reported complication of hip intra-articular corticosteroid injection (IACSI). Upon observing a high rate of FHC after hip IACSI, we sought to (1) describe how we addressed the problem through a systematic evaluation of clinica...

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Autores principales:	Brandon J Kelly, Benjamin R Williams, Amy A Gravely, Kersten Schwanz, V Franklin Sechriest
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5c9e97d1a36546a5950c5e35e87e5a29
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spelling	oai:doaj.org-article:5c9e97d1a36546a5950c5e35e87e5a292021-12-02T20:04:33ZFemoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.1932-620310.1371/journal.pone.0259242https://doaj.org/article/5c9e97d1a36546a5950c5e35e87e5a292021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0259242https://doaj.org/toc/1932-6203<h4>Introduction</h4>Femoral head collapse (FHC) is a rarely reported complication of hip intra-articular corticosteroid injection (IACSI). Upon observing a high rate of FHC after hip IACSI, we sought to (1) describe how we addressed the problem through a systematic evaluation of clinical data and institutional care practices followed by process improvement efforts; and (2) report our results.<h4>Methods</h4>Patients receiving hip IACSI during a 27-month period underwent retrospective review to determine the rate of FHC and to identify associated patient factors or practice shortfalls. Findings led to institution-wide interventions: (1) to improve patient/provider awareness of this association; and (2) to develop/implement practice guidelines. Rates of FHC after hip IACSI and practice patterns among providers before and after intervention were compared.<h4>Results</h4>Initial FHC rate after hip IACSI was 20.4%. Patient-related factors included body mass index (p = 0.025), history of cancer therapy (p = 0.012), Vitamin D level (p = 0.030), and multiple injections (p = 0.004). Volume/dose of injectate and post-injection surveillance methods varied widely. Quality improvement (QI) intervention resulted in fewer treatment referrals (from 851 to 436), fewer repeat injections (mean = 1.61 to 1.37; p = 0.0006), and a 5% lower FHC rate (p = 0.1292). Variation in practice patterns persisted, so a systems-based Clinical Pathway was established.<h4>Discussion</h4>When a high rate of FHC after hip IACSI was found to be associated with certain patient and practice factors, introduction of education materials and treatment guidelines decreased number of referrals, number of injections per patient, and FHC rate. In the absence of the systems-based Pathway, the type, dose, and volume of injectate and post-procedure follow-up remained variable.Brandon J KellyBenjamin R WilliamsAmy A GravelyKersten SchwanzV Franklin SechriestPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0259242 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Brandon J Kelly Benjamin R Williams Amy A Gravely Kersten Schwanz V Franklin Sechriest Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.
description	<h4>Introduction</h4>Femoral head collapse (FHC) is a rarely reported complication of hip intra-articular corticosteroid injection (IACSI). Upon observing a high rate of FHC after hip IACSI, we sought to (1) describe how we addressed the problem through a systematic evaluation of clinical data and institutional care practices followed by process improvement efforts; and (2) report our results.<h4>Methods</h4>Patients receiving hip IACSI during a 27-month period underwent retrospective review to determine the rate of FHC and to identify associated patient factors or practice shortfalls. Findings led to institution-wide interventions: (1) to improve patient/provider awareness of this association; and (2) to develop/implement practice guidelines. Rates of FHC after hip IACSI and practice patterns among providers before and after intervention were compared.<h4>Results</h4>Initial FHC rate after hip IACSI was 20.4%. Patient-related factors included body mass index (p = 0.025), history of cancer therapy (p = 0.012), Vitamin D level (p = 0.030), and multiple injections (p = 0.004). Volume/dose of injectate and post-injection surveillance methods varied widely. Quality improvement (QI) intervention resulted in fewer treatment referrals (from 851 to 436), fewer repeat injections (mean = 1.61 to 1.37; p = 0.0006), and a 5% lower FHC rate (p = 0.1292). Variation in practice patterns persisted, so a systems-based Clinical Pathway was established.<h4>Discussion</h4>When a high rate of FHC after hip IACSI was found to be associated with certain patient and practice factors, introduction of education materials and treatment guidelines decreased number of referrals, number of injections per patient, and FHC rate. In the absence of the systems-based Pathway, the type, dose, and volume of injectate and post-procedure follow-up remained variable.
format	article
author	Brandon J Kelly Benjamin R Williams Amy A Gravely Kersten Schwanz V Franklin Sechriest
author_facet	Brandon J Kelly Benjamin R Williams Amy A Gravely Kersten Schwanz V Franklin Sechriest
author_sort	Brandon J Kelly
title	Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.
title_short	Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.
title_full	Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.
title_fullStr	Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.
title_full_unstemmed	Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.
title_sort	femoral head collapse after hip intra-articular corticosteroid injection: an institutional response to improve practice and increase patient safety.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/5c9e97d1a36546a5950c5e35e87e5a29
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Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety.

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