TY - JOUR

T1 - Change in orthopaedic surgeon behaviour by implementing evidence-based practice

AU - Vedel, Jens-Christian

AU - Hallager, Dennis Winge

AU - Penny, Jeanette Østergaard

AU - Jensen, Tommy Henning

AU - Sørensen, Thomas Juul

AU - Brorson, Stig

N1 - Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

PY - 2023

Y1 - 2023

N2 - INTRODUCTION: Orthopaedic practice is not always aligned with new evidence which may result in an evidence-practice gap. Our aim was to present and report the use of a new model for implementation of evidence-based practice using treatment of distal radius fractures (DRF) as an example.METHODS: A new implementation model from the Centre for Evidence-Based Orthopaedics (CEBO) was applied. It comprises four phases: 1) baseline practice is held up against best available evidence, and barriers to change are assessed. 2) A symposium involving all stakeholders discussing best evidence is held, and agreement on a new local guideline is obtained. 3) The new guideline based on the decisions at the symposium is prepared and implemented into daily clinical practice. 4) Changes in clinical practice are recorded. We applied the model on the clinical question of whether to use open reduction and internal fixation with a locked volar plate (VLP) or closed reduction and percutaneous pinning (CRPP) in adults with DRF.RESULTS: Prior to application of the CEBO model, only VLP was used in the department. Based on best evidence, the symposium found that a change in practice was justified. A local guideline stating CRPP as first surgical choice was implemented. If acceptable reduction could not be obtained, the procedure was converted to VLP. A year after implementation of the guideline, the rate of VLP had declined from 100% to 44%.CONCLUSION: It is feasible to change surgeons' practice according to best evidence using the CEBO model.FUNDING: None.TRIAL REGISTRATION: Not relevant.

AB - INTRODUCTION: Orthopaedic practice is not always aligned with new evidence which may result in an evidence-practice gap. Our aim was to present and report the use of a new model for implementation of evidence-based practice using treatment of distal radius fractures (DRF) as an example.METHODS: A new implementation model from the Centre for Evidence-Based Orthopaedics (CEBO) was applied. It comprises four phases: 1) baseline practice is held up against best available evidence, and barriers to change are assessed. 2) A symposium involving all stakeholders discussing best evidence is held, and agreement on a new local guideline is obtained. 3) The new guideline based on the decisions at the symposium is prepared and implemented into daily clinical practice. 4) Changes in clinical practice are recorded. We applied the model on the clinical question of whether to use open reduction and internal fixation with a locked volar plate (VLP) or closed reduction and percutaneous pinning (CRPP) in adults with DRF.RESULTS: Prior to application of the CEBO model, only VLP was used in the department. Based on best evidence, the symposium found that a change in practice was justified. A local guideline stating CRPP as first surgical choice was implemented. If acceptable reduction could not be obtained, the procedure was converted to VLP. A year after implementation of the guideline, the rate of VLP had declined from 100% to 44%.CONCLUSION: It is feasible to change surgeons' practice according to best evidence using the CEBO model.FUNDING: None.TRIAL REGISTRATION: Not relevant.

KW - Adult

KW - Humans

KW - Orthopedic Surgeons

KW - Evidence-Based Practice

KW - Evidence Gaps

KW - Surgeons

KW - Fracture Fixation, Internal

KW - Wrist Fractures

M3 - Journal article

C2 - 37341352

VL - 70

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 6

M1 - A06220415

ER -