A comparative analysis of ENP's and SHO's in the application of the Ottawa ankle rules

This study investigates the comparative effectiveness of Senior House Officers (SHOs) and Emergency Nurse Practitioners (ENPs) in the application of the Ottawa ankle rules, in a large inner city Emergency Department in the United Kingdom (UK). Sixty patients with ankle injuries were randomly included in this study which took place in the minor injuries unit of the ED over a 12month period. Data were obtained retrospectively from the patients records relating to six individual aspects of the Ottawa ankle rules. Sixty patients were selected and divided equally between the ENPs and SHOs. The results show a variation between the ENPs and SHOs in application of individual criteria of the Ottawa ankle rules. ENPs more commonly documented bony tenderness to lateral and/or medial malleoli than the SHOs. However, the SHOs documentation of their diagnostic testing was superior with the ENPs failing to document what X-rays 17 patients received. The study demonstrates a statistically significant difference between the two groups of health practitioners. In all but one of the five subquestions of the Ottawa ankle rules there was a statistical significance of 0.053 or less. This clearly shows a difference in the documentation of the Ottawa ankle rules by the health practitioners questioning whether appropriate care is given. Both groups were poor at documenting negative findings and neither consistently documented their application of the Ottawa ankle rules either in part or its entirety.