dc.contributor.author | Bessen, T. | |
dc.contributor.author | Clark, R. | |
dc.contributor.author | Shakib, S. | |
dc.contributor.author | Hughes, G. | |
dc.date.accessioned | 2022-11-30T13:39:16Z | |
dc.date.available | 2022-11-30T13:39:16Z | |
dc.date.issued | 2009 | |
dc.identifier.citation | Bessen, T., Clark, R., Shakib, S. & Hughes, G. (2009). A Multifaceted Strategy for Implementation of the Ottawa Ankles Rules in Two Emergency Departments. Bmj. | en_US |
dc.identifier.uri | https://hdl.handle.net/11250/3035104 | |
dc.description.abstract | Problem Despite widespread acceptance of the Ottawa ankle rules for assessment of acute ankle injuries, their application varies considerably.
Design Before and after study.
Background and setting Emergency departments of a tertiary teaching hospital and a community hospital in Australia.
Key measures for improvement Documentation of the Ottawa ankle rules, proportion of patients referred for radiography, proportion of radiographs showing a fracture.
Strategies for change Education, a problem specific radiography request form, reminders, audit and feedback, and using radiographers as “gatekeepers.”
Effects of change Documentation of the Ottawa ankle rules improved from 57.5% to 94.7% at the tertiary hospital, and 51.6% to 80.8% at the community hospital (P<0.001 for both). The proportion of patients undergoing radiography fell from 95.8% to 87.2% at the tertiary hospital, and from 91.4% to 78.9% at the community hospital (P<0.001 for both). The proportion of radiographs showing a fracture increased from 20.4% to 27.1% at the tertiary hospital (P=0.069), and 15.2% to 27.2% (P=0.002) at the community hospital. The missed fracture rate increased from 0% to 2.9% at the tertiary hospital and from 0% to 1.6% at the community hospital compared with baseline (P=0.783 and P=0.747).
Lessons learnt Assessment of case note documentation has limitations. Clinician groups seem to differ in their capacity and willingness to change their practice. A multifaceted change strategy including a problem specific radiography request form can improve the selection of patients for radiography. | en_US |
dc.publisher | BMJ Journals | en_US |
dc.rights | Navngivelse-Ikkekommersiell 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/deed.no | * |
dc.subject | clinical diagnostic tests | en_US |
dc.subject | radiology | en_US |
dc.subject | radiology (diagnostics) | en_US |
dc.subject | injury | en_US |
dc.title | A Multifaceted Strategy for Implementation of the Ottawa Ankles Rules in Two Emergency Departments | en_US |
dc.type | Journal article | en_US |
dc.source.journal | BMJ Journals | en_US |
dc.identifier.doi | https://doi.org/10.1136/bmj.b3056 | |
dc.source.articlenumber | b3056 | en_US |