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Administrative data

NCT number NCT01654393
Other study ID # H12-01352
Secondary ID
Status Unknown status
Phase N/A
First received July 27, 2012
Last updated September 10, 2012
Start date July 2012
Est. completion date February 2013

Study information

Verified date September 2012
Source Vancouver Coastal Health
Contact Jan Buchanan, BSN
Phone 6048754205
Email Jan.Buchanan@vch.ca
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

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.


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.


Recruitment information / eligibility

Status Unknown status
Enrollment 142
Est. completion date February 2013
Est. primary completion date January 2013
Accepts healthy volunteers No
Gender All
Age group 19 Years and older
Eligibility 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

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Triage nurses applying the OAR
Triage nurses applying the OAR during assessment and ordering foot/ankle x-rays as necessary.

Locations

Country Name City State
Canada Vancouver General Hospital Vancouver British Columbia

Sponsors (2)

Lead Sponsor Collaborator
Vancouver Coastal Health University of British Columbia

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries Median LOS will be measured and compared among patients with ankle injuries that were assessed by OAR trained triage nurses who applied the OAR and ordered X-rays if necessary vs those patients who were triaged as per usual practice, with no OAR application. 6 months
Secondary Fracture missed by Triage Nurse: Assess if fractures were missed by triage nurse via + X-rays ordered by EP or via follow-up questionnaire 2 weeks later to determine if other investigations were performed after the pt's visit to the ED Estimated at 6 months.
Secondary Triage nurses' satisfaction Assess triage nurse' feedback regarding comfortability in applying the OAR, training, and whether the OAR has increased workload. estimated at 6 months
Secondary Percent agreement regarding necessity for X-ray between emergency nurse and physician estimated at 6 months
Secondary Emergency physician's compliance with OAR Determine if emergency physicians are applying OAR during this study period estimated at 6 months
Secondary Patient satisfaction with triage nurse initiated imaging Estimated at 6 months
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