A collaborative system to improve compartment syndrome recognition

Joshua K. Schaffzin, Heather Prichard, Jennifer Bisig, Peggy Gainor, Krista Wolfe, Lauren G. Solan, Laurie Webster, James J. McCarthy

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


BACKGROUND AND OBJECTIVE: Acute compartment syndrome (ACS) is a rare but serious complication of extremity injury that can cause permanent damage or death. ACS development is variable and unpredictable, and delay in recognition or treatment of ACS can lead to significant morbidity. Our objective was to create a reliable system for recognition of patients at risk and monitoring for ACS that could withstand frequent provider turnover. METHODS: Using the Model for Improvement, we identified key drivers and failure modes for 2 processes: Resident and nurse practitioner proper order entry and bedside nurse proper documentation of monitoring. Interventions were tested in frequent plan-do-study-act cycles. Effective interventions were used in combination to test for sustainability. RESULTS: Proper order entry increased from 23% at baseline to 90%. Proper documentation for patients with correct orders increased from 15% to 70%. Individual interventions, including pocket card distribution, electronic medical record order set, and direct discussion by team leaders, were associated with improvement among residents but were not sustained with team turnover. Incorporating all 4 individual interventions into the on-boarding process for residents produced consistent success. Nursing documentation improved with education and maintenance of proper order entry. CONCLUSIONS: We built a reliable, sustainable system to recognize and monitor patients at risk for ACS. Interventions designed to minimally disrupt existing workflows were individually associated with improvement. We achieved sustainability through staff turnover when we incorporated the interventions into routine orientation for new staff. Hospitals can use existing orders and protocols to sustain surveillance for ACS and other acute conditions. Pediatrics 2013;132:e1672- e1679.

Original languageEnglish (US)
Pages (from-to)e1672-e1679
Issue number6
StatePublished - Dec 2013
Externally publishedYes


  • Compartment syndrome
  • Injury prevention
  • Orthopedics
  • Quality improvement
  • Reliability science


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