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Uptake of validated clinical practice guidelines: experience with implementing the Ottawa Ankle Rules
Brian R Holroyd1, Deborah Wilson, Brian H Rowe
1Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. brian.rowe@ualberta.ca
The American Journal of Emergency Medicine
|May 13, 2004
Summary
Disseminating the Ottawa Ankle Rules (OARs) through multiple strategies did not reduce radiography use among emergency physicians. Further research is needed to find effective methods for guideline implementation in emergency settings.
Area of Science:
- Emergency Medicine
- Radiography Utilization
- Clinical Practice Guidelines
Background:
- The Ottawa Ankle Rules (OARs) are evidence-based guidelines designed to reduce unnecessary extremity radiography in emergency departments.
- Effective dissemination strategies are crucial for the successful implementation of clinical guidelines into practice.
Purpose of the Study:
- To evaluate the impact of multiple dissemination strategies on radiography use by emergency physicians (EPs) for the Ottawa Ankle Rules (OARs).
Main Methods:
- A prospective cohort study was conducted over two years, comparing two intervention hospitals with two control hospitals.
- All EPs received paper-based OARs; intervention groups additionally received sequential, targeted dissemination approaches.
- Radiography ordering rates for extremity injuries were monitored throughout the study period.
Main Results:
- Provincewide dissemination of OARs did not significantly decrease radiography use during the initial run-in period (92% vs. 93%; P =.36).
- Sequential directed education and personalized feedback strategies failed to reduce radiographic ordering rates over time (P =.54).
- The ordering of both foot and ankle radiographs also did not decrease significantly (P =.11).
Conclusions:
- Despite employing various dissemination strategies, the study did not observe a reduction in radiography use for ankle and foot injuries.
- Additional research is necessary to identify the most effective methods for integrating clinical guidelines, such as the OARs, into routine emergency department practice.