AN AUDIT OF MUSCULOSKELETAL (MSK) EXAMINATION IN MEDICAL PATIENTS PRESENTING WITH FALLS AND A SURVEY OF JUNIOR DOCTORS' LOCOMOTOR EXAMINATION SKILLS
Rheumatology Department, Luton & Dunstable NHS Trust, Luton, United Kingdom
Background: It has long been recognised that MSK examination is often ignored in routine patient assessments. Arguably, it is even more important in patients presenting to hospitals with mobility issues as it can have a huge impact on length of stay and discharge planning. In order to achieve better standard of patient care, the admitting doctor needs to be able to confidently perform the locomotor examination and elicit relevant findings.
Objectives: Aim of the audit was to see whether MSK examination was routinely undertaken in appropriate patients and the survey was carried out to ascertain doctors' level of training and confidence in performing locomotor examination.
Methods: 60 patients admitted with primary complaint of mobility issues at our institution were randomly identified over a six month period. The notes were audited to see whether any form of MSK examination was carried out during their admission and if it affected the length of stay. A survey of 21 junior doctors involved in the clerking process was also conducted to assess the training they had and whether they felt confident to carry out the examination.
Results: 31 (51%) of patients did not have any MSK examination done at all. Of the remaining, 21 (35%) had a very brief, mostly inadequate, examination performed in the Emergency department. Only four patients (6%) had any form of MSK assessment done by senior clinicians. The survey comprised mainly Foundation year 1 (FY1) doctors (76%) and was represented by various medical schools both in and outside the country. Only four doctors (19%) had any formal MSK examination teaching since graduation and most doctors confessed to have either borderline (76%) or no (14%) confidence at all in performing locomotor examination.
Conclusions: To our knowledge, this is the first audit to demonstrate serious shortcomings in recording MSK examination findings in patients where the examination is most relevant. There was a trend towards prolonged length of stay as a result of these failings. Inadequate training and hence poor confidence among front line medical staff remains the main cause of this issue. Focused strategy and better training of junior doctors, both during and after graduation, are pivotal to providing better care for patients presenting with musculoskeletal problems.
Disclosure of Interest: None Declared
Citation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 112
Session: Abstract Session: Education by learning
(Oral Presentations )