Closing the loop on tourniquet safety in distal radius fracture fixation surgery: a two-cycle quality improvement project.

Abstract

The application of intraoperative tourniquets is a fundamental component of distal radius fracture surgery, yet it carries a risk of significant complications. The British Orthopaedic Association (BOA) has published safety guidelines (BOA Standards for Trauma (BOAST)) to standardise practice, but adherence is often suboptimal. This quality improvement project aimed to evaluate and improve compliance with these guidelines in a real-world clinical setting. A two-cycle retrospective audit was conducted at a major trauma centre in the UK. The first cycle (January to April 2023, n=34) established baseline compliance with seven key BOAST documentation standards. Following this, a multifaceted intervention was implemented, including staff education, the introduction of a standardised checklist and the placement of visual reminders in operating theatres. A re-audit was then conducted (May to June 2024, n=63) to measure the impact of these interventions. Baseline documentation compliance was extremely low, with only tourniquet pressure recorded in 20.5% (7/34) and tourniquet time documented in 55.9% (19/34). Following the interventions, documentation of tourniquet pressure increased to 59.0% (37/63) and tourniquet site, padding, compressive exsanguination, skin condition, tourniquet size and tourniquet time showed modest improvements. Overall compliance, however, remained below optimal levels. A targeted quality improvement initiative combining education and practical tools can lead to meaningful improvements in adherence to tourniquet safety guidelines. Despite these gains, persistent documentation gaps highlight the need for more robust, system-level solutions, such as integration into electronic health records, to ensure sustained compliance and enhance patient safety.