DDH

Report
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

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