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 clinic...

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Autores principales: Brandon J. Kelly, Benjamin R. Williams, Amy A. Gravely, Kersten Schwanz, V. Franklin Sechriest
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Publicado: Public Library of Science (PLoS) 2021
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spelling oai:doaj.org-article:9f6ef7d5b5514bb3bcbc08428d4e503e2021-11-11T06:44:19ZFemoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety1932-6203https://doaj.org/article/9f6ef7d5b5514bb3bcbc08428d4e503e2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562809/?tool=EBIhttps://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 (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/9f6ef7d5b5514bb3bcbc08428d4e503e
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AT amyagravely femoralheadcollapseafterhipintraarticularcorticosteroidinjectionaninstitutionalresponsetoimprovepracticeandincreasepatientsafety
AT kerstenschwanz femoralheadcollapseafterhipintraarticularcorticosteroidinjectionaninstitutionalresponsetoimprovepracticeandincreasepatientsafety
AT vfranklinsechriest femoralheadcollapseafterhipintraarticularcorticosteroidinjectionaninstitutionalresponsetoimprovepracticeandincreasepatientsafety
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