Multimedia Health Education Can It Change Clinical Practice?
Assoc Prof Leo Donnan Director of Orthopaedics Chief of Surgery RCH
What is DDH?
A condition of the childs hip where there is incomplete development Range of disorders including - instability, subluxation and dislocation
If unstable hips are not detected and treated they may - not develop properly and eventually fail
The Impetus to do something
In Victoria children are still presenting with a late diagnosis of hip dislocation despite screening programs and use of ultrasound Children facing lifelong disability from a condition that is easily managed if detected early
Victorian Screening Program
72,000 births per year Geographically Spread 4.0 million in Melbourne 2.0 million in the “bush”
Clinical examination at birth six weeks regular intervals up to age two Ultrasound abnormal clinical findings risk factors at six weeks
Poor documentation No uniform standard of examination Inconsistency in terminology Increased reliance on imaging Unclear referral mechanisms Multiple examiners
The Scale of things
72,000 births per year Expect 72 frank dislocations 720 unstable hips ???? dysplastic hips 1012 MCH nurses in full/part time positions large work force dispersed will see very low rates of dislocation hrad to maintain skills
The Solution ?
Target the front line clinicians Understand their difficulties Define the barriers to early detection Develop evidence based practice guidelines Standardise the clinical examination Apply education theory principles
Knowledge - terminology, anatomy, pathology, associations, risk factors, examination, imaging Change practice - improve clinical skills, confidence and referral procedures Standardise approach health professionals - consistency across all
Education level Cultural background Social class Literacy skills Trust in the information Emotional state
Visual Auditory Written Kinesthetic
Pictures Words Sound
Developing the Module
Focus groups Literature review Educational objectives Outcome measures Script development Story board Animation Testing
Testing the Module
Maternal and Child Health Nurses Range of municipalities 203 recruited
Information easy to understand
Recommend the use of the module
Module met educational needs
p < 0.001
Change in Clinical Practice
How frequently do you examine for DDH? (n=164) How often do you perform the examination from the side of the infant? (n=164) Desired Change Pre Three Months Two Years 99% 100% 100% 34% 23% >0.05
Do you refer all infants with “ clicks ” in isolation for further assessment? (n=162) Do you fully unclothe infants to examine their hips? (n=162) Desired Change Pre 88% 99% Three Months Two Years 46% >0.001
Hip creases are the most important physical feature of DDH (n=164) In a relaxed baby it is important to push firmly in testing for hip instability (n=162) Desired Change Pre Three Months Two Years 42% 43% 24% >0.01
The relationship between delayed motor development and untreated DDH is very strong (n=161) Desired Change Pre 57% Three Months Two Years 60% 0.5
Increase accessibility of module online resource roll out to other clinical groups general practitioners midwives paediatricians Update the module response to feedback Watch for changes swaddling module developed
Recent trend for settling babies What ’s old is new again!!
High risk for DDH if not practiced safely
Has it made a difference?
MOR at RCH (year to date)
This initiative is aimed at improving the health and well being of children by facilitating early diagnosis and referral of DDH The module significantly improves the clinicians knowledge, skills and confidence in making the diagnosis Aim to ultimately reduce the need for complex surgery due to late diagnosis
Refresh your knowledge Update your skills Use the resources