RT Journal Article SR Electronic T1 Audit of upper limb fracture management in an accident and emergency department. JF Journal of Accident & Emergency Medicine JO Arch Emerg Med FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine SP 105 OP 108 DO 10.1136/emj.11.2.105 VO 11 IS 2 A1 D P Jenkins A1 M W Cooke A1 E E Glucksman YR 1994 UL http://emj.bmj.com/content/11/2/105.abstract AB The objective of this study was to audit the initial management of patients with upper limb fractures, and to determine whether the accident and emergency (A&E) management of fractures is improved by using guidelines for treatment and referral. This was achieved by comparing the standard of treatment, as determined by fracture clinic doctors, before and after the introduction of fracture treatment guidelines in the A&E department of a London teaching hospital. A total of 326 patients seen in the department and referred to the fracture clinic over two 2-month periods were included in the audit. The first audit revealed some error in 69/215 (32.1%) referrals and 51/215 (23.7%) of these were potentially liable to increased morbidity. After introducing the guidelines the total errors fell to 14/111 (12.6%) patients referred, of which only eight patients (7.2%) were at risk of increased morbidity. This represents an overall improvement of 19.5% [95% confidence interval (CI) 12.3 to 29.7%] and a 16.5% (95% CI 9.1 to 23.9%) reduction in the potentially more significant errors. Hence, the use of audit and implementation of simple guidelines for fracture management in an A&E department improves the standard of treatment.