Effect of triage nurse‐led application of the Ottawa Ankle Rules on number of radiographic tests and length of stay in selected emergency departments in Oman

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Fatema H. Al Abri ◽  
Joshua K. Muliira ◽  
Huda Al Awaisi
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Triage Nurse ◽  
Ottawa Ankle Rules

scholarly journals Effect of Triage Nurse Initiated Radiography Using the Ottawa Ankle Rules on Emergency Department Length of Stay at a Tertiary Centre

CJEM ◽  
2015 ◽  
Vol 18 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Wailliam W. Lee ◽  
Lyne Filiatrault ◽  
Riyad B. Abu-Laban ◽  
Anita Rashidi ◽  
Lawrence Yau ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Local Context ◽  
Power Calculation ◽  
Triage Nurse ◽  
Tertiary Care Centre ◽  
Tertiary Centre ◽  
Ottawa Ankle Rules

AbstractObjectiveTo determine the effect of triage nurse initiated radiographs using the Ottawa Ankle Rules (OAR) on emergency department (ED) throughput. We hypothesized OAR use would reduce median ED length of stay (LOS) by 25 minutes or more.MethodsA randomized controlled trial was conducted at a tertiary centre ED with an annual census of over 90,000 patients. Adult patients presenting within 10 days of isolated blunt ankle trauma were eligible. Participants were randomly assigned to standard triage or OAR application by 15 explicitly trained triage nurses. Our primary outcome was ED LOS. Secondary outcomes included triage nurses' and patients’ satisfaction. A power calculation indicated 142 patients were required. The Mann-Whitney U test was used to compare the medians between the two groups.ResultsOf 176 patients with blunt ankle injury screened, 146 were enrolled (83.0%); baseline characteristics in the two groups were similar. The median/mean ED LOS in the control and OAR groups were 128/143 minutes and 108/115 minutes respectively (median difference 20 minutes; p=0.003). Agreement in OAR use between emergency physicians and nurses was moderate (kappa 0.46/0.77 for foot/ankle rule components), and satisfaction of both nurses and participants was high.ConclusionTriage nurse initiated radiography using OAR leads to a statistically significant decrease of 20 minutes in the median ED LOS at a tertiary care centre. The overall impact of implementing such a process is likely site-specific, and the decision to do so should involve consideration of the local context.

scholarly journals Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses

2016 ◽  
Vol 67 (11) ◽  
pp. 1169-1174 ◽  
Author(s):  
Joseph L. Smith ◽  
Alessandro S. De Nadai ◽  
Eric A. Storch ◽  
Barbara Langland-Orban ◽  
Etienne Pracht ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Psychiatric Diagnoses

scholarly journals Increasing Length of Stay Among Adult Visits to U.S. Emergency Departments, 2001-2005

2009 ◽  
Vol 16 (7) ◽  
pp. 609-616 ◽  
Author(s):  
Andrew Herring ◽  
Andrew Wilper ◽  
David U. Himmelstein ◽  
Steffie Woolhandler ◽  
Janice A. Espinola ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments

scholarly journals A multifaceted strategy for implementation of the Ottawa ankle rules in two emergency departments

BMJ ◽  
2009 ◽  
Vol 339 (aug12 3) ◽  
pp. b3056-b3056 ◽  
Author(s):  
T. Bessen ◽  
R. Clark ◽  
S. Shakib ◽  
G. Hughes
Keyword(s):  
Emergency Departments ◽  
Ottawa Ankle Rules

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

scholarly journals LO35: A province-wide quality improvement collaborative for treatment of children's pain in Alberta's emergency departments

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S19-S19
Author(s):  
J. Thull-Freedman ◽  
E. Pols ◽  
A. McFetridge ◽  
S. Libbey ◽  
K. Lonergan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Pain Score ◽  
Emergency Departments ◽  
Control Charts ◽  
Interrupted Time Series ◽  
Quality Improvement Collaborative ◽  
Topical Anesthetic ◽  
Children's Pain ◽  
Underlying Trend

Background: Pediatric pain is often under-treated in emergency departments (EDs), causing short and long-term harm. In Alberta EDs, children's pain outcomes were unknown. A recent quality improvement collaborative (QIC) led by our team improved children's pain care in 4 urban EDs. We then spread to all EDs in Alberta using the Institute for Healthcare Improvement Framework for Going to Full Scale. Aim Statement: To increase the proportion of children <12 years who receive topical anesthetic before needle procedures from 11% to 50%; and for children <17 years with fractures: to 1) increase the proportion receiving analgesia from 31% to 50%; 2) increase the proportion with pain score documentation from 24% to 50%, and 3) reduce time to analgesia from 60 to 30 minutes, within 1 year. Measures & Design: All 97 EDs in Alberta that treat children were invited. Each was asked to form a project team, attend webinars, develop key driver diagrams and perform PDSA tests of change. Sites were given a monthly list of randomly selected charts for audit and entered data in REDCap for upload to a provincial run chart dashboard. Baseline performance measurement informed aims. Measures included proportion of children <12 years undergoing a lab test who received topical anesthetic, and for children <17 years with fracture, the proportion with a pain score, proportion receiving analgesia and median minutes to analgesia. Length of stay and use of opioids were balancing measures. Control charts were used to detect special cause. Interrupted time series (ITS) was performed to assess significance and trends. Evaluation/Results: 36 sites (37%) participated, including rural and urban sites from all regions. 8417 visits were audited. 23/36 sites completed audits before and after tests of change and were analyzed. Special cause occurred for all aims. The proportion receiving topical anesthetic increased from 11% to 30% (ITS p < 0. 001). For children with fractures, the proportion with pain scores increased from 24% to 34% (ITS p = 0.21, underlying trend present), proportion receiving analgesic medication increased from 31% to 39% (ITS p = 0.41, underlying trend present) and minutes to analgesia decreased from 60 to 28 (ITS p < 0. 01). There was no increase in length of stay or use of opioid medications. Discussion/Impact: A pragmatic approach encouraging locally led change was well-received and key to success. The QIC method shows promise for improving outcomes in diverse EDs across large geographic areas. Next steps include further spread and sustainability measurement.

scholarly journals Factors associated with the length of stay in emergency departments in Southern-Ethiopia

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Getahun H/meskel Alemu ◽  
Keneni Gutema Negari ◽  
Kaleb Mayisso Rodamo ◽  
Agete Tadewos Hirigo
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Southern Ethiopia ◽  
Factors Associated
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