Quick Response Codes on Casts Improve Adherence to Care Plan

June 16, 2020 - A new study released as part of the American Academy of Orthopaedic Surgeons (AAOS) Virtual Education Experience, found that quick response (QR) codes may be an effective method to relay follow-up instructions once patients are sent home with a cast.

The study, QR Codes- Alternative Methods for Cast Care Instructions in Children, leveraged data on 88 children who did not require surgery for a fracture. A waterproof QR code was put directly onto the patient’s cast.

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 study said.

Out of 60 children who used the QR code, nearly 90 percent of patients found it convenient and useful.

Seventy-four percent of patients were satisfied with the convenience and 37 of the 60 (61 percent) of patients who scanned the code said the information on the website allowed them to avoid reaching out to a physician to ask a question, researchers stated.

Patients and their caregivers run the risk of forgetting what was said in written instructions or losing them altogether after patients leave the clinic or hospital. 

The study noted that the total number of fractures in 2010 was 15 million. One in every five children is at risk for a fracture and children ages 10-14 years old have the greatest risk. 

Studies have proven that only 50 percent of the information presented during an office visit is retained by patients and 40 to 80 percent of the information is forgotten immediately, researchers highlighted.

Children and their families often find it challenging to remember cast care instructions due to the already heightened stress of a broken bone. Some remember only 14 percent of recommended care. 

"The genesis for this study was that most patients don't recall what you tell them in the clinic or office," John Schlechter, DO, FAAOS, pediatric orthopedic surgeon, Children's Hospital Orange County, Orange, California, said in the study. 

"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."

A family member was able to participate in the study and complete a follow-up questionnaire if they had a smartphone. 

The majority of casts in the study were short arm casts (40.9 percent), followed by long arm casts (33 percent) and short leg casts (21.6 percent).

The QR code was scanned an average of 1.6 times. Most of the scans (65.8 percent) were scanned by a parent.

A very small percentage of participants found complications while using the QR code. Three individuals said the code would not scan and two reported the QR code fell off the cast.

Additionally, only 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 Schlechter, MD. 

"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."