Triage nurses order x-rays for patients with isolated distal limb injuries: A 12-month ED study

To determine whether triage nurses could safely, accurately, and appropriately order x-rays for patients with distal limb injuries.

All adult patients presenting to the emergency department of a tertiary teaching hospital for 12 months with distal limb injuries were eligible for the study. Patients with severe pain or evidence of acute neurovascular compromise were excluded. Triage nurses who had completed a training workshop offered patients the option of having an x-ray obtained before seeing a physician. Data were collected regarding the number and type of x-rays ordered, the number of positive x-ray findings on radiologic review, and violations of x-ray ordering guidelines. All ED distal limb x-rays ordered during the 12-month study period were analyzed for type, frequency, and abnormality. To determine the impact of the project on practice, all triage nurses were given the opportunity to complete a questionnaire, patient satisfaction surveys were conducted, and structured interviews were conducted with senior ED medical and radiography personnel.

During the 12-month study, triage nurses ordered 876 x-rays (49%), whereas physicians ordered 930 x-rays (51%). Medical staff and triage nurses ordered equal proportions of upper and lower limb x-rays. The abnormality rate in the total study group was 699 (39%). The abnormality rate for x-rays when comparing nursing and medical staff was 43% (390) and 33% (309), respectively (x(2) = 23.4; P <.0001). The triage x-ray abnormality rate for the upper limb was 51%, compared with 31% for the lower limb. Data indicated that all staff believed that this new triage practice had increased patient satisfaction and improved patient flow and waiting times.

With structured education, triage nurses at one institution safely assessed patients and ordered appropriate distal limb x-rays prior to physician assessment.