A Nursing Triage Protocol for Minor Orthopedic Traumata: the Effect on Flow Time, Quality of Care and Patient Satisfaction in an Emergency Department

Study Overview
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Brief Summary
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In 2019, nearly half of all hospital contacts in Belgium took place through the emergency department, and more than a third of patients arrived after an accident or trauma. In instances of overcrowding, patients with minor orthopedic injuries face prolonged waiting times. Previous studies have shown that implementing triage protocols for medical imaging conducted by a triage nurse can reduce the Total Length of Stay (TLOS) for this patient group. This is a single-center, unblinded, randomized, controlled trial that aims to evaluate the impact of a nurse triage protocol on turnaround time (primary outcome), quality of care, and patient satisfaction. The study population consists of adults who present with minor orthopedic injuries below the elbow or knee and have an Emergency Severity Index (ESI) of 4 or 5. Participants are randomly assigned to either the 'nurse triage protocol' group (n=110) or the 'usual care' group (n=110).

Official Title
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A Nursing Triage Protocol for Minor Orthopedic Traumata: the Effect on Flow Time, Quality of Care and Patient Satisfaction in an Emergency Department

Conditions
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Trauma Injury

Intervention / Treatment
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* Diagnostic Test: Nursing triage protocol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults (18 years old) ESI 4 or ESI 5 Recent trauma (< 10 days after trauma) Accidental trauma mechanism Trauma below the elbow (forearm, wrist, hand, finger) Trauma below the knee (lower leg, ankle, foot, toe) Exclusion Criteria: ESI 1 or ESI 2 or ESI 3 Return visit after previous emergency department contact for the same injury (e.g. increased pain, tight cast, ...) Trauma resulting from underlying somatic pathology (e.g. syncope, epileptic attack, vertigo, vasovagal collapse, ...) Atraumatic (pain) complaints (e.g. pain in the calf, toe, foot, wrist, ... without a clear trauma mechanism) Additional, non-orthopedic injuries (e.g. laceration, signs of cerebral commotion, ...) Pregnancy or a suspicion of pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention group and control group
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nursing triage group<br>Using a triage protocol for medical imaging conducted by a triage nurse in the emergency department | Diagnostic Test: Nursing triage protocol<br>* Medically approved and supervised standing order that allows trained ER nurses to start medical imaging (RX) for adult patients with minor traumata to the limbs.<br>|
| No Intervention: Regular care group<br>Regular triage in the emergency department | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| TLOS | Total length of stay | 6-8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient satisfaction | Patient satisfaction measured by a 10-point Likert scale at discharge using a questionnaire | 6-8 weeks | 
| Treatment efficiency | Measurement if the patient diagnosis and/or treatment was correctly initiated at the Emergency Department. Yes = no additional diagnosis or treatments were necessary; No = within 14 days after discharge a change in treatment or new diagnosis was done. Data will be collected using the hospital's patient records or by calling patients if no information is found in the record. | 6-8 weeks |