Ankle FractureNCT01654393
Triage Nurse Initiated Radiographs According to OAR
A study testing Triage nurses applying the OAR in people with Ankle Fracture, run by Vancouver Coastal Health at 1 site in Canada.
Trial summary
The purpose of the study is to help doctors in emergency departments know whether triage nurse initiated radiographs, in accordance to the Ottawa ankle rule, before emergency physician assessment will shorten emergency patients' visit. Read more about this study
- Who is it for?
- Ages 19 years and older
- Conditions the study is for
- Ankle Fracture
- What is being tested?
- Triage nurses applying the OAR
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 142 participants
- Where
- 1 siteCanada
- Study dates
- Jul 2012to Feb 2013
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients aged ≥ 19 presenting with an isolated blunt ankle injury
Who cannot join
- Injury >10 days
- Isolated skin injury
- Referred patient with outside x-ray
- Obvious fracture or deformity
- Polytrauma
- Pregnancy
Show all 10Show fewer
- Diminished sensation due to neurological deficit
- Uncooperative, intoxicated or patients with altered mental status
- Patients returning for reassessment of same injury
- Injury due to or suspicious for domestic violence
Trial locations and contacts
1 site in 1 country.
Lyne Filiatrault, MD contact
Canada1 site, 1 recruiting
- Recruiting
Vancouver General Hospital
Vancouver, British Columbia, V5Z 1M9
Jan Buchanan, BSN, 6048754205, Jan.Buchanan@vch.ca
Wailliam W Lee, MD, wailliamlee37@gmail.com
About this study
Official title: Can Triage Nurse Initiated Radiographs in Accordance With the Ottawa Ankle Rule Shorten Emergency Department Length of Stay At a Tertiary Care Center?
The purpose of the study is to help doctors in emergency departments know whether triage nurse initiated radiographs, in accordance to the Ottawa ankle rule, before emergency physician assessment will shorten emergency patients' visit. The investigators will examine the number of missed fractures between the two groups, the emergency physicians' willingness to apply OAR and triage nurses' satisfaction.
Read the detailed description
Overcrowding in the emergency department (ED) has been an ongoing issue for many hospitals in North America. Numerous strategies have been implemented and explored in hopes of reducing wait times and length of stay. The Ottawa ankle rules are one such strategy developed and proven to reduce cost and wait time without patient dissatisfaction and missed fractures. As a result, they have gained widespread acceptance from emergency physicians around the world.
Since the implementation of the Ottawa ankle rules (OAR), numerous studies have examined nurses' application and interpretation of these rules. It has been shown that nurses' application of the rule yield similar sensitivity and negative predictability for diagnosis of fractures as physicians. It is believed that emergency nurses can make accurate assessment in the determination of the patients who require radiographs. What is unclear, however, is whether or not triage nurse initiated radiographs shortens patients' length of stay in the emergency department, a factor inversely correlated to patient satisfaction. Only a couple of studies have looked at this issue in the context of the Ottawa ankle rules. One is a retrospective study conducted at an A\&E department in a small city while the other, although randomized prospectively, was carried out in an urgent care center rather than in a busy academic tertiary care hospital.
Our primary objective for this study is to investigate the median length of stay of patients presenting to a tertiary care academic center with blunt ankle injuries and assess whether triage nurse initiated radiographs in accordance to the Ottawa ankle rules would shorten their stay versus current standard of care. Presently, the emergency physician orders the x-ray at the time of patient encounter.
- Conditions
- Ankle Fracture
- Being tested
- Triage nurses applying the OAR
- Keywords
- Triage nurse, Ottawa ankle rules
- Medical subject headings
- Ankle Fractures
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Triage nurses applying the OAROther
Triage nurses applying the OAR during assessment and ordering foot/ankle x-rays as necessary.
| Study group | Role | What they receive |
|---|---|---|
| OAR group | Experimental | Patients with ankle injuries who are assessed by OAR trained triage nurses applying the OAR. Receives: Other: Triage nurses applying the OAR |
| Control for OAR Triage Nurses | No intervention | Patients with ankle injuries that are seen by OAR triage nurses but not assessed in accordance with the OAR. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries
Median LOS will be measured and compared among patients with ankle injuries that were assessed by OAR trained triage nurses who applied the OAR and ordered X-rays if necessary vs those patients who were triaged as per usual practice, with no OAR application.
Measured: 6 months
Secondary outcomes (5)
Fracture missed by Triage Nurse:
Assess if fractures were missed by triage nurse via + X-rays ordered by EP or via follow-up questionnaire 2 weeks later to determine if other investigations were performed after the pt's visit to the ED
Measured: Estimated at 6 months.
Triage nurses' satisfaction
Assess triage nurse' feedback regarding comfortability in applying the OAR, training, and whether the OAR has increased workload.
Measured: estimated at 6 months
Percent agreement regarding necessity for X-ray between emergency nurse and physician
Measured: estimated at 6 months
Emergency physician's compliance with OAR
Determine if emergency physicians are applying OAR during this study period
Measured: estimated at 6 months
Patient satisfaction with triage nurse initiated imaging
Measured: Estimated at 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Jul 2012 (estimated)
- Study startJul 2012
- Primary completionJan 2013 (estimated)
- Study completionFeb 2013 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Ankle FractureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Care provider
- Enrolment
- 142 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Vancouver Coastal Health
- Sponsor type
- Other government
- Collaborators
- University of British Columbia
- Responsible party
- Principal investigator, Dr. Lyne Filiatrault, Vancouver Coastal Health
- Investigators
- Lyne Filiatrault, MD, FRCPC, Principal investigator, Vancouver Coastal Health AuthoritiesWailliam W Lee, MD, Principal investigator, Vancouver Costal Health AuthoritiesRyiad Abu-Laban, MD, MHSc, FRCPC, Principal investigator, Vancouver Costal Health Authorities
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01654393
- Sponsor's protocol ID
- H12-01352
- Status last verified
- Sep 2012
- First submitted
- 27 Jul 2012
- Last updated
- 12 Sep 2012
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 12 Sep 2012. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Can Triage Nurse Initiated Radiographs in Accordance With the Ottawa Ankle Rule Shorten Emergency Department Length of Stay At a Tertiary Care Center?
- ClinicalTrials.gov ID
- NCT01654393
- Acronym / sponsor ID
- H12-01352
- Conditions
- Ankle Fracture
- Keywords
- Triage nurse, Ottawa ankle rules
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 142 participants (estimated)
- Lead sponsor
- Vancouver Coastal HealthOther government
- Collaborators
- University of British Columbia
- Study start
- Jul 2012
- Primary completion
- Jan 2013 (estimated)
- Study completion
- Feb 2013 (estimated)
- First posted
- 31 Jul 2012 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of the study is to help doctors in emergency departments know whether triage nurse initiated radiographs, in accordance to the Ottawa ankle rule, before emergency physician assessment will shorten emergency patients' visit. The investigators will examine the number of missed fractures between the two groups, the emergency physicians' willingness to apply OAR and triage nurses' satisfaction.
Detailed description
Overcrowding in the emergency department (ED) has been an ongoing issue for many hospitals in North America. Numerous strategies have been implemented and explored in hopes of reducing wait times and length of stay. The Ottawa ankle rules are one such strategy developed and proven to reduce cost and wait time without patient dissatisfaction and missed fractures. As a result, they have gained widespread acceptance from emergency physicians around the world.
Since the implementation of the Ottawa ankle rules (OAR), numerous studies have examined nurses' application and interpretation of these rules. It has been shown that nurses' application of the rule yield similar sensitivity and negative predictability for diagnosis of fractures as physicians. It is believed that emergency nurses can make accurate assessment in the determination of the patients who require radiographs. What is unclear, however, is whether or not triage nurse initiated radiographs shortens patients' length of stay in the emergency department, a factor inversely correlated to patient satisfaction. Only a couple of studies have looked at this issue in the context of the Ottawa ankle rules. One is a retrospective study conducted at an A\&E department in a small city while the other, although randomized prospectively, was carried out in an urgent care center rather than in a busy academic tertiary care hospital.
Our primary objective for this study is to investigate the median length of stay of patients presenting to a tertiary care academic center with blunt ankle injuries and assess whether triage nurse initiated radiographs in accordance to the Ottawa ankle rules would shorten their stay versus current standard of care. Presently, the emergency physician orders the x-ray at the time of patient encounter.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, care provider)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| OAR group | Experimental | Other: Triage nurses applying the OARPatients with ankle injuries who are assessed by OAR trained triage nurses applying the OAR. |
| Control for OAR Triage Nurses | No intervention | –Patients with ankle injuries that are seen by OAR triage nurses but not assessed in accordance with the OAR. |
Who may qualify
- Ages
- 19 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Patients aged ≥ 19 presenting with an isolated blunt ankle injury
Key exclusion criteria (10 listed)
- Injury >10 days
- Isolated skin injury
- Referred patient with outside x-ray
- Obvious fracture or deformity
- Polytrauma
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Triage nurses applying the OARTriage nurses applying the OAR during assessment and ordering foot/ankle x-rays as necessary. | Other | OAR group |
Primary outcome
Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries
Time frame: 6 months
Median LOS will be measured and compared among patients with ankle injuries that were assessed by OAR trained triage nurses who applied the OAR and ordered X-rays if necessary vs those patients who were triaged as per usual practice, with no OAR application.
5 secondary outcomes
Fracture missed by Triage Nurse:
Time frame: Estimated at 6 months.
Triage nurses' satisfaction
Time frame: estimated at 6 months
Percent agreement regarding necessity for X-ray between emergency nurse and physician
Time frame: estimated at 6 months
Emergency physician's compliance with OAR
Time frame: estimated at 6 months
Patient satisfaction with triage nurse initiated imaging
Time frame: Estimated at 6 months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Sep 2012.
Related trials for Ankle Fracture
Not yet recruiting
Biodegradable Magnesium Screws for Unstable Ankle Fracture Surgery
Ankle Fractures, Syndesmotic Injury
Recruiting
Investigating Auto Adjusting Dynamic AFO
Lower Limb; Fusion, Congenital, Lower Limb Fracture
Recruiting
Lateral Ankle Treatment
Avulsion Fracture
RecruitingObservational study
Use of Bioresorbable Magnesium Set Screws in Syndesmotic Injuries: a Pilot Study
Syndesmotic Injury, Trimalleolar Fracture
Not yet recruiting
Outpatient Floor Pedal Bike Utilization
Femur Fracture, Tibia Fracture
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Lyne Filiatrault, MD contact
Lyne Filiatrault, MD, FRCPC principal investigator
Vancouver Coastal Health Authorities
Wailliam W Lee, MD principal investigator
Vancouver Costal Health Authorities
Ryiad Abu-Laban, MD, MHSc, FRCPC principal investigator
Vancouver Costal Health Authorities
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Triage nurses applying the OAR in people with Ankle Fracture, run by Vancouver Coastal Health at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 12 Sep 2012. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Jan Buchanan, BSN (6048754205, Jan.Buchanan@vch.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries (time frame: 6 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Sep 2012.