Nurse-initiated x-ray of isolated limb fractures in the emergency department: research outcomes and future directions.

Patients presenting at emergency departments with isolated limb trauma face chronic delays due to over crowding and over utilisation of these departments for primary health care. Excessive waiting periods for assessment, definitive diagnostic procedures and subsequent treatment plans compound the current access block for emergency care, with these factors contributing to patient dissatisfaction. To improve patient satisfaction and decrease waiting times for some patients, the literature suggests that nurse initiated x-rays at the point of triage may be of value. Nurses can appropriately determine the need for radiological assessment in patients with isolated limb trauma--a high correlation has been found between doctors' and nurses' ordering of x-rays. To ensure x-rays are accurately and appropriately ordered, it is suggested that strict guidelines and structured educational programmes for nurses be implemented. The findings from this literature review suggest that extending the triage role to include nurse initiated x-rays has the potential to decrease waiting times and to increase patient satisfaction in the emergency department.