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
The Problem
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
Objectives
Knowledge - terminology, anatomy, pathology,
associations, risk factors, examination, imaging
Change practice - improve clinical skills,
confidence and referral procedures
Standardise approach - consistency across all
health professionals
Learning Ability
Education level
Cultural background
Social class
Literacy skills
Trust in the information
Emotional state
Challenge
High
ANXIETY
BOREDOM
Low
High
Skill
Learning Types
Visual
Auditory
Written
Kinesthetic
Pictures
Sound
Words
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
Knowledge
P< 0.001
P< 0.001
Confidence
p < 0.001
Change in Clinical Practice
Desired
Change
Pre
Three
Months
Two
Years
How frequently do you examine
for DDH? (n=164)
99%
100%
100%
How often do you perform the
examination from the side of the
infant? (n=164)
34%
23%
21%
>0.05
>0.01
Desired
Change
Pre
Three
Months
Two
Years
Do you refer all infants with
“clicks” in isolation for further
assessment? (n=162)
88%
46%
34%
>0.001
>0.001
Do you fully unclothe infants to
examine their hips? (n=162)
99%
91%
90%
>0.001
0.003
Desired
Change
Pre
Three
Months
Two
Years
Hip creases are the most
important physical feature of
DDH (n=164)
42%
24%
19%
>0.01
>0.01
In a relaxed baby it is important
to push firmly in testing for hip
instability (n=162)
43%
60%
46%
>0.01
0.77
Desired
Change
The relationship between
delayed motor development and
untreated DDH is very strong
(n=161)
Pre
Three
Months
Two
Years
57%
60%
58%
0.5
0.5
What now?
Increase accessibility of module
Update the module
online resource
roll out to other clinical groups
general practitioners
midwives
paediatricians
response to feedback
Watch for changes
swaddling module developed
Swaddling
Recent trend for settling babies
What’s old is new again!!
High risk for DDH if not practiced safely
Navaho Indians
Has it made a difference?
MOR at RCH
(year to date)
Summary
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
Take Home
Refresh your knowledge
Update your skills
Use the resources
0
