Case study. Fractured ankle.

To improve our practice performance for patients admitted to the emergency department with fractured ankles, our Clinical Quality Improvement Team (CQI) developed the Fractured Ankle Critical Path, for patients needing open reduction and internal fixation, but for whom surgery could or should be deferred as determined by the orthopaedic surgeon. Members of the team included an orthopaedic trauma surgeon, an emergency department physician, case managers, and representatives of the Home Care Department at Rhode Island Hospital. The critical path includes a Home Care referral procedure, an R.I. Hospital Fracture and Orthopaedic Information Sheet, and a Fractured Ankle Home Care Protocol. The goal of the Fractured Ankle Critical Path is to decrease length of stay while maintaining positive outcomes.