Simulation-based training reduces unnecessary ultrasound referrals for developmental dysplasia of the hip in newborns

Background

Developmental dysplasia of the hip is a common newborn condition characterized by malformation or instability of the hip joint. Identifying dysplasia of the hip early is imperative for avoiding long-term consequences. In the United States, dysplasia of the hip screening of newborns uses the Ortolani and Barlow maneuvers. However, evidence suggests that inadequate training in these techniques may lead to unnecessary imaging referrals for further assessment. We investigated the impact of a dysplasia of the hip simulator (MiHip) and its associated training program on ultrasound referral rates and cost-savings at a single institution.

Methods

From July 2021 to June 2022, 54 residents on newborn rotations underwent training using the MiHip curriculum. All newborns born at our institution 1 year prior (n = 5,404) and 1-year posttraining period (n = 5,792) were identified. High-risk factors warranting automatic ultrasound referrals (family history of dysplasia of the hip, breech presentation, and multiple births) were excluded. χ² tests were used to compare pre- and posttraining incidences of dysplasia of the hip–relevant and unnecessary (defined as dysplasia of the hip–negative) ultrasound referrals. P ≤ .05 was considered statistically significant, and effect, ω ≥ 0.30 considered moderate.

Results

Initial referral rates for dysplasia of the hip decreased by 34.07%, χ² (1, N = 5,031) = 34.41, P = .02, ω = 0.08. Unnecessary referrals decreased by 23%, χ² (1, N = 33) = 17.96, P = .04, ω = 0.74. This coincided with a $14,400 annual savings.

Conclusion

The MiHip training curriculum significantly reduced unnecessary ultrasound referrals, demonstrating the value of simulation-based training in enhancing dysplasia of the hip examination skills. This training has the potential to lower financial and emotional burdens associated with extensive imaging, specialist consultations, and follow-up care.