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Abstract
Background Scalp lacerations are a common presentation to the Emergency Department (ED). The Hair Apposition Technique (HAT) is a safe, effective, efficient and patient-centred alternative to sutures and commonly used in paediatrics. This Quality Improvement Project (QIP) was inspired by a patient with dementia who could not tolerate sutures for her scalp laceration therefore HAT was used with excellent results and patient satisfaction. This project aimed to introduce the technique to 50% of all eligible adult patients within 6 months.
Method and results A retrospective, case-note baseline review demonstrated no use of HAT in adults during a period of three months. Barrier analysis using staff surveys explored why HAT was not standard practice. We introduced HAT using the Institute of Healthcare Improvement (IHI)’s Model for improvement methodology and conducted four Plan, Do, See, Act (PDSA) cycles to implement changes. Our process measure was the number of patients having HAT compared with sutures. Outcome measures were via a qualitative phone survey evaluating pain, satisfaction and inconvenience score on a scale of 0–10. Balancing measures included wound complication and re-attendance.
Conclusions During the 6 months following the introduction of HAT 71% patients who were eligible to have HAT had the technique instead of sutures or staples, with improvement in all patient outcome measures compared with those who had sutures. HAT was popular with staff and patients. Our sustainability review at one year showed ongoing use of the technique and we have achieved a significant culture change by establishing the technique as standard practice for adults.
Breakdown of head lacerations and their closure by month comparing a 3-month period, one year apart
Graph to show impact of PDSA Cycles on the No. of Patients Having Either Sutures/Staples vs. HAT Over Time
Run chart comparing the Baseline results with HAT for Pain scores
Conclusion HAT should be considered in eligible adult patients with scalp lacerations presenting to the ED. Applying quality improvement methodology resulted in a sustained culture change; the ED involved now offers an effective suture free paediatric technique to adults which has improved patient outcomes and satisfaction.