Implementation and Evaluation of the Ottawa Ankle Rules in Pediatric Orthopedic Triage

Abstract

Problem & Purpose: Overcrowding of emergency departments (EDs) is a national healthcare crisis, which include pediatric EDs (PEDs). During overcrowding, the length of stay (LOS) for patients with low acuity distal orthopedic complaints is longer than all other complaints combined at this site. This PED has no interventions to expedite care during high patient volume scenarios. This project implemented and evaluated the Ottawa Ankle Rules (OARs) in a PED. The OARs is a clinical decision tool to aid clinicians in determining if a patient requires radiography for ankle or foot injuries. Nurses implemented this tool in triage on patients to expedite diagnostic imaging prior to physician assessment to decrease LOS and door to diagnostic evaluation times. Methods: Nurses implemented the OARs on all pediatric patients 5 years and older presenting to the PED with ankle or foot complaints. Data on median times for both total emergency department LOS and ankle or foot complaint patients as well as door to diagnostic evaluation were collected. The percentage of nurses compliant to the OARs and nurses’ education completion percentage was also collected. Results: There was 100% adherence of the nurses in implementing the intervention and 100% education completion by the sixth week of implementation. Median door to diagnostic evaluation time decreased to 29 minutes from 31 minutes pre- versus post-intervention. The total EDLOS did not change during the implementation of the intervention; however, when compared to the same months in the previous year, there was a 26.15-minute decrease in median total EDLOS. There was a 2-minute increase in EDLOS for ankle/foot patients. Conclusions: Findings suggest implementing the OARs in PED triage can decrease EDLOS, and nurses are able to comply with the OARs in triage. Incorporation of the OARs into written PED protocol was conducted for sustainability. Implications of these data suggested using the OARs in similar settings is feasible and may decrease EDLOS.