Triage Nurse Initiated Radiographs According to OAR

The recruitment status of this study is unknown because the information has not been verified recently.
Verified September 2012 by Vancouver Coastal Health.
Recruitment status was  Recruiting
Sponsor:
Collaborator:
University of British Columbia
Information provided by (Responsible Party):
Dr. Lyne Filiatrault, Vancouver Coastal Health
ClinicalTrials.gov Identifier:
NCT01654393
First received: July 27, 2012
Last updated: September 10, 2012
Last verified: September 2012
  Purpose

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.


Condition Intervention
Ankle Fracture
Other: Triage nurses applying the OAR

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver)
Primary Purpose: Health Services Research
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?

Resource links provided by NLM:


Further study details as provided by Vancouver Coastal Health:

Primary Outcome Measures:
  • Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    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.


Secondary Outcome Measures:
  • Fracture missed by Triage Nurse: [ Time Frame: Estimated at 6 months. ] [ Designated as safety issue: No ]
    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

  • Triage nurses' satisfaction [ Time Frame: estimated at 6 months ] [ Designated as safety issue: No ]
    Assess triage nurse' feedback regarding comfortability in applying the OAR, training, and whether the OAR has increased workload.

  • Percent agreement regarding necessity for X-ray between emergency nurse and physician [ Time Frame: estimated at 6 months ] [ Designated as safety issue: Yes ]
  • Emergency physician's compliance with OAR [ Time Frame: estimated at 6 months ] [ Designated as safety issue: No ]
    Determine if emergency physicians are applying OAR during this study period

  • Patient satisfaction with triage nurse initiated imaging [ Time Frame: Estimated at 6 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 142
Study Start Date: July 2012
Estimated Study Completion Date: February 2013
Estimated Primary Completion Date: January 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: OAR group
Patients with ankle injuries who are assessed by OAR trained triage nurses applying the OAR.
Other: Triage nurses applying the OAR
Triage nurses applying the OAR during assessment and ordering foot/ankle x-rays as necessary.
No Intervention: Control for OAR Triage Nurses
Patients with ankle injuries that are seen by OAR triage nurses but not assessed in accordance with the OAR.

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

Ages Eligible for Study:   19 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
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
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01654393

Contacts
Contact: Jan Buchanan, BSN 6048754205 Jan.Buchanan@vch.ca
Contact: Lyne Filiatrault, MD filiatra@mail.ubc.ca

Locations
Canada, British Columbia
Vancouver General Hospital Recruiting
Vancouver, British Columbia, Canada, V5Z 1M9
Contact: Jan Buchanan, BSN    6048754205    Jan.Buchanan@vch.ca   
Contact: Wailliam W Lee, MD       wailliamlee37@gmail.com   
Principal Investigator: Wailliam Lee, MD         
Principal Investigator: Lyne Filiatrault, MD, FRCPC         
Principal Investigator: Ryiad Abu-Laban, MD, MHSc, FRCPC         
Sponsors and Collaborators
Vancouver Coastal Health
University of British Columbia
Investigators
Principal Investigator: Lyne Filiatrault, MD, FRCPC Vancouver Coastal Health Authorities
Principal Investigator: Wailliam W Lee, MD Vancouver Costal Health Authorities
Principal Investigator: Ryiad Abu-Laban, MD, MHSc, FRCPC Vancouver Costal Health Authorities
  More Information

No publications provided

Responsible Party: Dr. Lyne Filiatrault, Emergency Physician, Vancouver Coastal Health
ClinicalTrials.gov Identifier: NCT01654393     History of Changes
Other Study ID Numbers: H12-01352
Study First Received: July 27, 2012
Last Updated: September 10, 2012
Health Authority: Canada: Vancouver Costal Health Research Institute

Keywords provided by Vancouver Coastal Health:
Triage nurse
Ottawa ankle rules

Additional relevant MeSH terms:
Ankle Fractures
Fractures, Bone
Wounds and Injuries

ClinicalTrials.gov processed this record on September 30, 2014