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Improving the accuracy of digital templating: achieving success through stakeholder management
  1. Hammad Parwaiz,
  2. Boris Aliaga Crespo,
  3. Joshua Filer,
  4. Ashley Thorpe,
  5. Rosie Seatter,
  6. Dominique Suzanne Faulkner,
  7. Harvey Sandhu
  1. Trauma and Orthopaedics, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  1. Correspondence to Mr Hammad Parwaiz; hammad.parwaiz{at}


The use of a marker ball in digital templating for hip arthroplasty is a well-established method of preoperative planning and is used to overcome the inherent magnification in plain film radiographs. Our hospital policy is to place a marker ball in all anteroposterior pelvic films taken in the emergency department (ED) which have been requested for suspected neck of femur fractures. We carried out a baseline measurement followed by three Plan-Do-Study-Act cycles for all pelvic films taken in ED during July 2016, November 2016, February 2017 and November 2017. Interventions between the baseline measurement and cycle 1 were to educate the lead radiographer and publish the results in the radiology newsletter, and between cycles 1 and 2 was to run a teaching session for radiographers, display posters in the X-ray department and place an electronic prompt on the X-ray machine to alert them of the need to place a marker ball in the X-ray field. Cycle 3 looked to see if improvements were sustained. 16/81 (20%) radiographs complied with the policy in our baseline measurement; 25/51 (46%, p=0.002) in cycle 1; 40/54 (74%, p=0.0056) in cycle 2; and 48/63 (76%) in cycle 3. Our quality improvement project led to large improvements in clinical practice through straightforward, small, but appropriately targeted interventions. Stakeholder management is key to successfully implementing change. The next step is to switch from the VoyantMark to the KingMark marker ball, as it has greater accuracy of templating and is also easier to place within the field of an X-ray.

  • templating
  • marker ball
  • PDSA
  • stakeholder management
  • hip fracture

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  • Contributors All authors have contributed to the project and manuscript. HP designed the project, collected data, analysed data, presented results, carried out interventions between PDSA cycles and wrote the manuscript. BAC and JF collected data, analysed data, presented results and reviewed the manuscript. AT and RS collected data, analysed data, presented results, carried out interventions between PDSA cycles and reviewed the manuscript. DSF collected data, analysed data and presented results. HS supervised the project and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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