Clinical trial NCT01654393: Triage Nurse Initiated Radiographs According to OAR
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?
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Ankle Fracture
Keywords: Triage nurse
Ottawa ankle rules
Lead sponsor: Vancouver Coastal Health
Sponsor class: OTHER_GOV
Collaborators: name: University of British Columbia
First posted: 2012-07-31
Enrollment: 142
Sex: ALL
Minimum age (years): 19
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief 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.

Detailed 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.

Eligibility criteria: 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

Primary outcomes:
measure: Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries
timeFrame: 6 months
Secondary outcomes:
measure: Fracture missed by Triage Nurse:
timeFrame: Estimated at 6 months.
measure: Triage nurses' satisfaction
timeFrame: estimated at 6 months
measure: Percent agreement regarding necessity for X-ray between emergency nurse and physician
timeFrame: estimated at 6 months
measure: Emergency physician's compliance with OAR
timeFrame: estimated at 6 months
measure: Patient satisfaction with triage nurse initiated imaging
timeFrame: Estimated at 6 months
Other outcomes:
Locations:
city: Vancouver
country: Canada
facility: Vancouver General Hospital
state: British Columbia
Study officials:
affiliation: Vancouver Coastal Health Authorities
name: Lyne Filiatrault, MD, FRCPC
role: PRINCIPAL_INVESTIGATOR
affiliation: Vancouver Costal Health Authorities
name: Wailliam W Lee, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Vancouver Costal Health Authorities
name: Ryiad Abu-Laban, MD, MHSc, FRCPC
role: PRINCIPAL_INVESTIGATOR
References: