Do triage nurse-initiated X-rays for limb injuries reduce patient transit time?

Requesting Wrist Radiographs in Emergency Department Triage

“…Although we were unable to find formal studies that were conducted to evaluate patient satisfaction postimplementation of this initiative, it has been suggested by staff in numerous studies that patients who perceive ongoing assessment and investigation while waiting to see an EP report better satisfaction (Tambimuttu et al, 2002). Furthermore, the prospective, randomized controlled study by Lindley-Jones and Finalayson (2000) and the randomized, prospective comparison trial study by Parris et al (1997) found that nurse-requested radiographs led to higher staff satisfaction and a greater sense of teamwork. As such, finding ways to significantly reduce the waiting time required to transit from triage to radiology and from radiology to EP assessment is of significant value for patients and health care organizations alike.…”

“…The results of Kelly, McCarthy, Richardson, Parris, and Kerr (1995) suggested that the average timesavings for the patient could be in the order of 45 min. Others studies found that the timesavings for patients ranged from 8 to 60 min when nurses initiated radiographs at the point of triage (Davies, 1994, Macleod & Freeland 1992Parris et al, 1997). Furthermore, in a recent study, a decrease of 45 min in the overall waiting time was noted for patients with limb injuries when nurses utilized protocols (Sorensen et al, 2012).…”

“…Significant potential advantages can ensue if EDs adopt a triage nurse-requested radiographic protocol; patients can benefit from a significant time-saving of 36% in ED length of stay (M. Lindley-Jones & B. J Finlayson, 2000)-when nurses initiated radiographs in triage. In addition, the literature suggests that increased rates of patient and staff satisfaction may be achieved, without compromising quality of radiographic request or quality of service (W. Parris, S. McCarthy, A. M. Kelly, & S. Richardson, 1997). Studies have shown that nurses are capable of requesting appropriate radiographs on the basis of a preset protocol.…”

“…Developing a training program as well as a diagnostic algorithm that enables triage nurses to request wrist radiographs at the time of patient's initial presentation in our ED could potentially decrease waiting times, increase patient satisfaction, and produce a more efficient use of staff time (Parris et al, 1997). The knowledge acquired from the creation of such initiatives may be very helpful to develop future strategies that will aid in expediting care for patients who present with injuries of lesser acuity through the ED.…”

Emergency Department Overcrowding

“…Point-of-care testing and satellite laboratories produce quicker results [42] and may reduce LOS [43] although some studies failed to demonstrate this [44]. Nurse ordering of X-rays may speed up processes where fast track does not operate [45], although other studies have found conflicting results [46]. ED staff undertaking ultrasounds may reduce delays for those having this procedure [47].…”