Triage Nurse Initiated Radiographs According to OAR

NCT ID: NCT01654393

Last Updated: 2012-09-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

142 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-07-31

Study Completion Date

2013-02-28

Brief Summary

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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

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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.

Conditions

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Ankle Fracture

Keywords

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Triage nurse Ottawa ankle rules

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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OAR group

Patients with ankle injuries who are assessed by OAR trained triage nurses applying the OAR.

Group Type EXPERIMENTAL

Triage nurses applying the OAR

Intervention Type OTHER

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

Control for OAR Triage Nurses

Patients with ankle injuries that are seen by OAR triage nurses but not assessed in accordance with the OAR.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Triage nurses applying the OAR

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

Intervention Type OTHER

Eligibility Criteria

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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
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of British Columbia

OTHER

Sponsor Role collaborator

Vancouver Coastal Health

OTHER_GOV

Sponsor Role lead

Responsible Party

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Dr. Lyne Filiatrault

Emergency Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lyne Filiatrault, MD, FRCPC

Role: PRINCIPAL_INVESTIGATOR

Vancouver Coastal Health Authorities

Wailliam W Lee, MD

Role: PRINCIPAL_INVESTIGATOR

Vancouver Costal Health Authorities

Ryiad Abu-Laban, MD, MHSc, FRCPC

Role: PRINCIPAL_INVESTIGATOR

Vancouver Costal Health Authorities

Locations

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Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Jan Buchanan, BSN

Role: CONTACT

Phone: 6048754205

Email: [email protected]

Lyne Filiatrault, MD

Role: CONTACT

Email: [email protected]

Facility Contacts

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Jan Buchanan, BSN

Role: primary

Wailliam W Lee, MD

Role: backup

Other Identifiers

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H12-01352

Identifier Type: -

Identifier Source: org_study_id