Ankle radiograph utilization after learning a decision rule: a 12-month follow-up

Area of Science:

• Emergency Medicine
• Clinical Practice Guidelines
• Diagnostic Imaging

Background:

• The Ottawa ankle rules are a validated clinical decision tool designed to reduce unnecessary ankle radiography.
• Sustained adherence to clinical guidelines is crucial for effective healthcare delivery and resource optimization.

Purpose of the Study:

• To evaluate the long-term adherence to the Ottawa ankle rules in an emergency department setting.
• To determine if the reduction in ankle radiograph ordering was maintained 12 months after the initial implementation and training.

Main Methods:

• A before-after clinical trial design was employed in a university-based emergency department.
• The study compared ankle radiograph ordering rates for adult patients with acute ankle injuries during a 12-month intervention period and a subsequent 12-month postintervention period.
• The intervention involved teaching the Ottawa ankle rules and providing compliance feedback; no further intervention or surveillance occurred during the postintervention year.

Main Results:

• The proportion of eligible patients receiving ankle radiographs did not significantly differ between the intervention period (64.3%) and the postintervention period (62.2%).
• Radiograph ordering rates remained consistent throughout the 12-month postintervention period, with no significant decline observed.
• Physicians were unaware of the postintervention surveillance, minimizing potential Hawthorne effect bias.

Conclusions:

• Adherence to the Ottawa ankle rules was sustained for at least 12 months after the initial educational intervention and feedback period.
• Physicians demonstrated continued use of the clinical guideline once learned, suggesting effective knowledge transfer and integration into practice.
• Simple clinical guidelines, once mastered, can lead to lasting changes in physician behavior and diagnostic imaging practices.