# Operation Rate for Displaced Distal Radius Fractures in the Elderly Decreased by 68% After the Implementation of Evidence-Based Practice

## TL;DR

A new model called CEBO helped reduce surgery rates for wrist fractures in elderly patients by 68% by changing surgeon behavior based on evidence.

## Contribution

The CEBO model is introduced as a practical framework for implementing evidence-based changes in clinical decision-making.

## Key findings

- The operation rate for displaced distal radius fractures in the elderly dropped from 79% to 11% after applying the CEBO model.
- The CEBO model was found to be highly feasible for facilitating surgeon behavior change in an orthopedic surgery department.

## Abstract

Background

The increasing demand for orthopedic trauma surgery resources highlights the need for an efficient approach to implementing scientifically based interventions and de-implementation of interventions already in use that have been found no better than non-surgical treatments. Several factors have been identified as barriers or facilitators for translating evidence into clinical practice and behavioral changes. To facilitate a structured approach to applying these factors, we have adapted the generic theoretical domains framework (TDF) into the “CEBO model,” providing a practical framework for implementing evidence in clinical decision-making in the hospital department of Zealand University Hospital, Koege, Denmark.

Aim

This study aims to evaluate the feasibility of the CEBO model for facilitating surgeon behavior change in an orthopedic surgery department. We will present clinical decision-making regarding the treatment of dorsally displaced distal radius fractures (DDDRF) in the elderly as an example.

Methods

Our department's standard of care for DDDRF in the elderly was surgical treatment. Under the evolving body of evidence, the CEBO model was applied to facilitate change in treating surgeons’ behavior toward the increased use of non-surgical care. Following the four steps of the CEBO model, 1) leadership support was obtained, and relevant evidence was disseminated to all colleagues across the department; 2) stakeholders were invited to a symposium discussing best evidence and future practice; 3) conclusions from the symposium were summarized in a local clinical guideline stating non-surgical treatment as a new department standard and 4) to monitor the changes in treatment, patient charts were retrospectively reviewed from one year before and after the application of the CEBO model.

Results

In the first period, 95 of 120 (79%) were surgically treated, compared to 16 of 146 (11%) in the second period. An absolute decrease in the operation rate of 68% was observed.

Conclusion

We found the CEBO model highly feasible for facilitating surgeon behavior change in our orthopedic surgery department. Future studies will investigate the model's feasibility in other institutions and compare it to other behavior-targeted interventions.