Evaluating Compliance With the Ottawa Rules: A Retrospective Clinical Audit at a District General Hospital in the UK

Abstract

Background: The Ottawa Rules are clinical decision tools designed to assist healthcare providers in determining the need for radiographs in patients with ankle or knee injuries. Compliance with these rules can lead to more efficient use of resources and reduced radiation exposure. Objective: This retrospective clinical audit aimed to evaluate healthcare provider's compliance with the Ottawa Rules in an Emergency Department setting and assess the positivity rates of requested knee and ankle X-rays. Methods: A two-cycle retrospective audit was conducted at Lincoln County Hospital's Emergency Department, involving 648 X-rays collected in two cycles. In between, multiple interventions were implemented to improve the outcomes. Results: The study revealed varying levels of compliance with the Ottawa Rules, with higher compliance observed for knee X-rays than ankle X-rays. The compliance for knee X-rays improved from 74.6% to 89.9% and ankle X-rays improved from 33.1% to 75.8%. Positivity rates for ankle radiographs were higher than knee radiographs in both cycles. The interventions implemented between the cycles significantly improved compliance rates with the Ottawa Rules. Conclusion: The findings underscore the importance of adherence to the Ottawa Rules in optimizing patient care and resource utilization. The study suggests the need for continued education and periodic audits to maintain and further improve compliance rates. Additionally, the higher positivity rates for ankle radiographs highlight the importance of targeted imaging strategies based on clinical guidelines.