The development of a local clinical pathway for the management of high grade lateral ankle ligament injuries.

Purpose

High grade lateral ankle ligament injuries cause significant functional impact with the potential for pathological sequelae and a known socio-economic burden. Clinical guidelines exist but are limited in their translation in to local frameworks. The purpose of this clinical pathway was to standardise care for this specific group using current evidence and guidelines. This pathway also formed the main project for service development as part of the lead author’s involvement in the Royal College of Nursing Clinical Leadership Programme for multi-professional staff at Mid Yorkshire Hospitals NHS Trust. The aim was to improve patient outcomes, quality and standardise care for acute high grade lateral ankle ligament injuries through the development of an evidence based clinical pathway. The objective was to review the current evidence base and guidelines for the treatment of high grade lateral ankle ligament sprains and translate this in to a local clinical pathway via a multi-professional consensus group.

Approach

A criteria-based clinical pathway development using a multi-professional staged approach. Pathway stages involved initial analysis of local and regional practice, literature search of current evidence and guidelines, translation of literature into local pathway, review and development by consensus group, piloting of pathway and final implementation.

Outcomes

Results: Analysis of current in house practice and benchmarking exercise against other regional hospitals Trusts identified limited use of evidenced based clinical pathways for high grade lateral ankle ligament injuries. Literature search of evidence base guidelines identified 3 relevant articles which met search criteria. Articles were reviewed by the multidisciplinary group and translated into a local framework which detailed components of the treatment algorithm, timeframes and criteria-based progression. The framework was further reviewed by a multi-professional consensus group where agreement was reached on the clinical pathway. Piloting of the pathway was tested and subsequently the final clinical pathway was implemented resulting in standardisation of care for this specific clinical group. The pathway formed the main project for a Royal College of Nursing multi-professional leadership programme at Mid Yorkshire Hospitals NHS Trust.

Conclusion(s): High grade lateral ankle ligament injuries cause significant functional impact with the potential for pathological sequelae and known socio-economic burden. Clinical guidelines exist but limited translation in to local frameworks. Criteria-based development of a clinical pathway for the management of this specific group has resulted in an evidenced based pathway being implemented via a multi-professional consensus group.

Cost and savings

Not applicable. 

Implications

Implementation of this clinical pathway has standardised care for this clinical group at Mid Yorkshire Hospitals NHS Trust and allows outcomes to be audited and studied to further optimise patient care.

Top three learning points

No further information. 

Funding acknowledgements

Nil.