Triage Nurse Initiated Radiographs According to OAR

Vancouver Coastal Health

Status: Unknown

Conditions: Ankle Fracture

Treatments: Other: Triage nurses applying the OAR

Study type: Interventional

Funder types: Other

Identifiers

NCT01654393

H12-01352

Details and patient eligibility

About

The purpose of the study is to help doctors in emergency departments know whether triage nurse initiated radiographs, in accordance to the Ottawa ankle rule, before emergency physician assessment will shorten emergency patients' visit. The investigators will examine the number of missed fractures between the two groups, the emergency physicians' willingness to apply OAR and triage nurses' satisfaction.

Full description

Overcrowding in the emergency department (ED) has been an ongoing issue for many hospitals in North America. Numerous strategies have been implemented and explored in hopes of reducing wait times and length of stay. The Ottawa ankle rules are one such strategy developed and proven to reduce cost and wait time without patient dissatisfaction and missed fractures. As a result, they have gained widespread acceptance from emergency physicians around the world.

Since the implementation of the Ottawa ankle rules (OAR), numerous studies have examined nurses' application and interpretation of these rules. It has been shown that nurses' application of the rule yield similar sensitivity and negative predictability for diagnosis of fractures as physicians. It is believed that emergency nurses can make accurate assessment in the determination of the patients who require radiographs. What is unclear, however, is whether or not triage nurse initiated radiographs shortens patients' length of stay in the emergency department, a factor inversely correlated to patient satisfaction. Only a couple of studies have looked at this issue in the context of the Ottawa ankle rules. One is a retrospective study conducted at an A&E department in a small city while the other, although randomized prospectively, was carried out in an urgent care center rather than in a busy academic tertiary care hospital.

Our primary objective for this study is to investigate the median length of stay of patients presenting to a tertiary care academic center with blunt ankle injuries and assess whether triage nurse initiated radiographs in accordance to the Ottawa ankle rules would shorten their stay versus current standard of care. Presently, the emergency physician orders the x-ray at the time of patient encounter.

Enrollment: 142 estimated patients

Sex: All

Ages: 19+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients aged ≥ 19 presenting with an isolated blunt ankle injury

Exclusion criteria

• Injury >10 days
• Isolated skin injury
• Referred patient with outside x-ray
• Obvious fracture or deformity
• Polytrauma
• Pregnancy
• Diminished sensation due to neurological deficit
• Uncooperative, intoxicated or patients with altered mental status
• Patients returning for reassessment of same injury
• Injury due to or suspicious for domestic violence

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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142 participants in 2 patient groups

OAR group

Experimental group

Description:

Patients with ankle injuries who are assessed by OAR trained triage nurses applying the OAR.

Treatment:

Other: Triage nurses applying the OAR

Control for OAR Triage Nurses

No Intervention group

Description:

Patients with ankle injuries that are seen by OAR triage nurses but not assessed in accordance with the OAR.