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Triage nurse-initiated X-ray radiography in minor trauma
Julie Gautier1, Matthieu Verdan1, Emmanuelle Rochette2,3
1Urgences pédiatriques, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France.
Insights
Implementing triage nurse-initiated X-ray radiography significantly reduced paediatric emergency department (ED) length of stay. This protocol improved efficiency without compromising patient care quality.
Area of Science:
- Emergency Medicine
- Radiography
- Paediatric Care
Background:
- Paediatric emergency departments (EDs) face global overcrowding challenges.
- Improving the quality of care in busy EDs is a critical priority.
- This study investigates a novel approach to streamline patient flow.
Purpose of the Study:
- To evaluate the impact of triage nurse-initiated X-ray radiography on patient length of stay in paediatric EDs.
- To assess the efficiency and safety of empowering triage nurses with X-ray request authority.
Main Methods:
- Retrospective, monocentric study comparing two 3-month periods.
- Involved paediatric patients (≥3 years) with simple closed distal trauma.
- Assessed outcomes before and after implementing a nurse-initiated X-ray protocol.
Main Results:
- Median length of stay significantly reduced by 33% (39 minutes).
- Nurse-initiated X-ray requests were deemed adequate/sufficient in 95.2% of cases.
- Only 2.0% of requests were considered unnecessary, with 2.8% requiring additional imaging.
Conclusions:
- Triage nurse-initiated X-ray protocols effectively reduce paediatric ED length of stay.
- The protocol maintained the quality of patient management.
- Nurse X-ray requests demonstrated high relevance and accuracy.
Background:
Overcrowding of paediatric emergency departments (EDs) is a worldwide issue, where improving the quality of care is a priority. The main objective of this study was to determine the effect of triage nurse-initiated X-ray radiography on length of stay in paediatric emergency admissions.
Methods:
This retrospective, monocentric, descriptive study was performed in two successive 3-month periods: a pre-protocol ('before') period from 3 February to 3 May 2020 and a protocol ('after') period from 4 May to 2 August 2020, when patients underwent nurse-initiated X-ray radiography. The study involved all patients who were aged ≥3 years, valid, non-hyperalgic, accompanied by their parents and consulting at the paediatric ED for a simple closed distal trauma, involving a single limb segment or joint.
Results:
A total of 695 patients were included, 298 in the first period and 397 in the second period. The median length of stay in the paediatric ED was significantly shorter during the second period (119 min [80, 165] vs. 80 min [60, 105], P < 0.001), i.e. a median reduction time of 39 min or 33% (effect size = - 0.68, 95% confidence interval [-0.84 to -0.53]). Triage nurse requests were judged 'adequate and sufficient' in 95.2% of cases, with only 2.0% of instances deemed 'unnecessary' by the medical team. In 2.8% of cases, 'another X-ray' was required to support diagnosis.
Conclusions:
The application of a triage nurse X-ray protocol significantly reduced the length of stay in a paediatric ED. The quality of patient management remained unchanged, and nurse requests were relevant.
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