A case-control study of the transit times through an accident and emergency department of ankle injured patients assessed using the Ottawa Ankle Rules

Abstract

This paper reports part of a larger study of 354 consecutive attendances to an Accident and Emergency department by patients with ankle injuries. One hundred and ninety-nine patients met the criteria for inclusion in this study. The case study group (n =79) were those patients assessed by a nurse practitioner who had been trained in, and had authority to use of the Ottawa Ankle Rules (OAR) and were referred for radiographs from triage assessment. The control group (initially 120) consisted of those patients who were assessed by nurses who were not trained to be nurse practitioners and were not empowered to use the OAR but were sent for radiographs when assessed at the treatment stage. Sixteen patients were excluded from the study due to missing time data, reducing the control group to 104 patients. Previous studies have suggested that reductions in transit times through the department can be achieved by empowering nurses to request radiographs at the time of initial assessment, although these studies did not look specifically at the application of the OAR. Significant reductions in transit time are demonstrated for those patients who are required to have an X-ray to confirm a diagnosis if this is requested at the time of the triage assessment by nurse practitioners.