Can QR Codes Make a Difference for Children in Casts?

When children require a cast due to a bone fracture, follow-up care instructions are typically given verbally or the patient is sent home with written instructions. However, patients and their caregivers run the risk of forgetting what was said or losing the instructions. Quick Response (QR) codes may be an effective method to relay instructions once patients are sent home with a cast, according to a new study released as part of the American Academy of Orthopaedic Surgeons’ (AAOS) Virtual Education Experience.
 
“The genesis for this study was that most patients don’t recall what you tell them in the clinic or office,” said John Schlechter, D.O., FAAOS, pediatric orthopedic surgeon, Children’s Hospital Orange County, Orange, Calif. “When I talk to patients and their families about the course of action, I often have them record me on their smartphone because I know they don’t always take home all the information. If we put the QR code on the cast, they have on-demand access to instructions.”
 
The total number of fractures in 2010 was 15 million.ⁱ One in every five children is at risk for a fracture and children ages 10-14 years old have the greatest risk.ⁱⁱ Studies have shown that only 50 percent of the information presented during an office visit is retained by patients and 40 percent to 80 percent of the information is forgotten immediately.ⁱⁱⁱ Due to the stress of a broken bone, children and their families often find it difficult to recall cast care instructions, with some remembering as little of 14 percent.^iv.v
 
The prospective study, “QR Codes – Alternative Methods for Cast Care Instructions in Children,” collected data on 88 children between 0-18 years old who did not require surgery for a fracture. A family member had to own a smartphone to be included and complete a follow-up questionnaire. A laminated, waterproof QR code was put directly onto the cast. The researchers looked at cast complications, the number of times the QR code was scanned, who scanned the code, time of day scanned, treatment satisfaction, and whether the QR code helped prevent a call to a physician. The majority of casts were short arm casts (40.9 percent), followed by long arm casts (33 percent) and short leg casts (21.6 percent).
 
Of the children with a complete follow up, 60 used the QR code to answer questions they had about cast care. The QR code was mainly scanned by a parent (65.8 percent). The study also found:
 

• The QR code was scanned an average of 1.6 times (range = 0-8 times), although patients and their families thought they had scanned it an average of 2.4 times (range = 0-15).
• Ninety percent (89.9 percent) of the patients found the QR code convenient and useful (p < 0.001).
• Seventy-four percent (73.9 percent) of patients were very satisfied with the convenience.
• Thirty-seven of the 60 patients who scanned the code said the information on the website kept them from needing to contact a physician to ask a question.
• There were 11 cast-related issues with the primary reported circumstance being a wet or damaged cast.
• Of the participants who reported a problem with the QR code: Three said the code would not scan; two reported the QR code fell off the cast; one patient said they were unable to find the QR code on the cast; and one reported the code stopped working after the first scan.

 
“With patients of all ages, especially children, we are always trying to mitigate cast-related issues that can lead to unwanted emergency room visits,” said Dr. Schlechter. “Most cast complications are due to a wet cast. With QR codes, we can point patients and their caregivers to the exact website needed to access physician-specific information, which reassures them and provides reliable information.”

References
ⁱ Bone and Joint Initiative. Fracture Trends. https://www.boneandjointburden.org/2014-report/via23/fracture-trends. Updated 2014. Accessed Feb. 6, 2020.
ⁱⁱ Naranje SM, Erali RA, Warner WC, Sawyer JR, Kelly DM. Epidemiology of Pediatric Fractures Presenting to Emergency Departments in the United States. J Pediatr Orthop. 2016;36(4):e45-48.
ⁱⁱⁱ Robert H. Margolis P. In One Ear and Out the Other – What Patients Remember. Audiology Online; 2004 [cited 2019 October 17]; Available from: https://www.audiologyonline.com/articles/in-one-ear-and-out-1102. Accessed Jan. 21, 2020.
^iv Gough AT, Fieraru G, Gaffney P, Butler M, Kincaid RJ, Middleton RG. A novel use of QR code stickers after orthopaedic cast application. Ann R Coll Surg Engl. 2017 Jul;99(6):476-8.
^v Kessels RP. Patients’ memory for medical information. J R Soc Med. 2003 May;96(5):219-22.