Ankle Fracture Clinical Trial
Official title:
Can Triage Nurse Initiated Radiographs in Accordance With the Ottawa Ankle Rule Shorten Emergency Department Length of Stay At a Tertiary Care Center?
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.
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.
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