Clinical audit and the implementation of the Ottawa Ankle Rules

Abstract

PurposeTo implement the research‐based Ottawa Ankle Rules in a district hospital and audit their impact on the number and appropriateness of X‐rays for ankle injuries in A&E.Design/methodology/approachThe method used was retrospective data collection, followed by education and prospective data collection on the management of subsequent ankle injuries. The computer records of the first 150 people presenting to A&E with ankle/foot injuries in one month were reviewed to determine whether the patient underwent an X‐ray, and what the results were. Every doctor working in A&E was then educated using a hand‐out giving the Ottawa Ankle Rules. The management of 150 people presenting with ankle/foot injuries in the month after this intervention was assessed.FindingsThere was a reduction in the number of patients receiving X‐rays (83/150 or 55 per cent versus 128/150 or 85 per cent pre‐intervention; p<<0.001). There was also an increase in the proportion of X‐rays showing fractures (17/83 or 20 per cent versus 16/128 or 12.5 per cent; difference not statistically significant).Research limitations/implicationsPossible to stimulate good practice with audit.Practical implicationsImprovement in practice stimulated by a motivated trainee doctor with appropriate support. Factors contributing to success discussed.Originality/valueEncouraging example of successful audit, of interest to those interested in using clinical audit to improve care.

Requesting Wrist Radiographs in Emergency Department Triage

“…If the guideline indicates that a radiograph is needed, the nurse can order it according to protocol (Sorensen et al, 2012). Study results indicated that when nurses abided by these principles, a reduction of 30% regarding the number of radiographic requests was noted (Jennings, Newton, Bonner, & Hancock, 2005).…”