Can nurses working in remote units accurately request and interpret radiographs?

Area of Science:

• Emergency Medicine
• Radiology
• Nursing Practice

Background:

• NHS reforms empower nurses in advanced roles, including emergency nurse practitioners (ENPs).
• Telemedicine is increasingly used to support remote healthcare facilities, particularly for emergency consultations.
• Peripheral limb trauma consultations frequently require radiographic imaging for accurate diagnosis.

Purpose of the Study:

• To evaluate the ability of nurses in peripheral units to appropriately request radiographs for limb trauma.
• To assess the accuracy of nurses' interpretation of peripheral limb radiographs.
• To determine the feasibility of nurse-led radiography in remote emergency settings.

Main Methods:

• Prospective study involving four qualified nurses in a peripheral unit requesting defined radiographs.
• Nurses received protocol-specific training and support.
• Radiograph appropriateness was independently assessed by two senior emergency physicians (one in-person, one via telemedicine).
• Nurse interpretations were compared against a gold standard including physician assessments and radiologist reports.

Main Results:

• 300 radiographs were analyzed over 12 months; 31% showed bony trauma or foreign bodies.
• 11 (3.7%) radiographs were deemed inappropriate by emergency physicians.
• Nurses incorrectly interpreted 10.7% of radiographs (26 false positives, 4 false negatives).
• Nurse interpretation achieved 96% sensitivity and 87% specificity.

Conclusions:

• Experienced nurses can appropriately request peripheral limb radiographs without constant medical supervision.
• Nurses demonstrate a high standard of accuracy in interpreting these radiographs.
• A tendency towards false positives in nurse interpretations suggests a cautious approach.