[X-ray requests for minor limb injuries. A systematic review]

Abstract

X-ray requests for minor limb trauma: a systematic review.

Introduction: Overcrowding in Emergency Department (ED) leads to an increased waiting time causing dissatisfaction both in patients and staff, in addition to possible negative events.

Aim: To assess if the request of x-rays by triage nurses, for isolated injuries, during the waiting time before the physician assessment, might improve the flow of ED patient, affecting the lenght of stay (LOS) and the waiting time in the department. Nurses' satisfaction in addition to the accuracy of the requested x-rays was also assessed.

Methods: A systematic review was conducted according to the PRISMA method, questioning PUBMED and CINAHL databases, selecting full text articles from the year 1995 and considering only adult population.

Results: 14 studies were selected: 7 RCT, 5 observational studies, 1 pilot study and 1 quasi-experimental study. The request of x-rays by the triage nurses significantly improved the waiting and staying time in the ED together with the patients and staff's satisfaction.

Conclusions: Anticipating the x-rays requests during triage can be a solution for reducing waiting and staying time in the ED. In addition, it impacts also on patients and nurses' satisfaction. The accuracy of x-rays is strictly linked to Nurses' education and the use of validated tools like Ottawa Ankle Rules, which had good feedback from the nursing staff.