Wallace William, Limaye Neil, Rao Chirag, Menon Siddharth, Ratcliffe George, Mostafa Ahmed, Blakeley Christopher
Department of Emergency Medicine, Croydon Health Service National Health Service (NHS) Trust, London, GBR.
Department of Emergency Medicine, Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, GBR.
Cureus. 2025 May 27;17(5):e84908. doi: 10.7759/cureus.84908. eCollection 2025 May.
Introduction Traumatic foot and ankle injuries are frequent presentations to the emergency department (ED). The Ottawa Foot and Ankle (F&A) Rules are to help clinicians in decision making whether an X-ray of the foot or ankle is justified. Methods A retrospective analysis of ankle and foot X-ray requests from a South London Hospital ED was performed. Consecutive requests for both foot and ankle X-rays were assessed chronologically until n=100 for each cohort. The clinical documentation of each ED clerking and the X-ray request clinical details were then compared to the Ottawa Rules of that respective request. The presence of a midfoot or ankle fracture was recorded. Several interventions were implemented to improve compliance; this included distributing the results of the first audit cycle and a handout containing the Ottawa F&A rules to ED staff. A teaching session for ED Junior Doctors on assessing, documenting, and requesting X-rays for foot and ankle injuries was delivered within the department. An identical second retrospective audit cycle for both ankle and foot X-rays was then completed three weeks after implementation of the above interventions. Results The compliance of Ottawa Foot Rules in documenting foot injuries significantly improved from 48% to 78% (p<.001). Foot X-ray request compliance significantly improved from 32% to 54% (p<.01). Documentation compliance of ankle injuries significantly improved from 74% to 87% (p<.05). Ankle injury X-ray request compliance improved from 43% to 57% (p<.05). Fracture rate did not significantly change; ankle fractures increased from 17% to 22% (p=.372), foot fracture rate remained 15% in both cycles. Significance was assessed using the Chi-square test throughout. Conclusion This two-cycle Quality Improvement Project demonstrated significant improvement in compliance with Ottawa F&A Rules for ED clerking documentation and X-ray request clinical details in a South London Hospital. Compliance with Ottawa F&A Rules has the potential to reduce costs, facilitate faster discharge, and reduce unnecessary radiation exposure.
引言 创伤性足踝损伤是急诊科常见的就诊情况。渥太华足踝（F&A）规则旨在帮助临床医生决定是否有必要对足部或踝部进行X光检查。方法 对伦敦南部一家医院急诊科的足踝X光检查申请进行回顾性分析。按时间顺序评估连续的足部和踝部X光检查申请，每个队列直至n = 100。然后将每份急诊科病历记录的临床资料以及X光检查申请的临床细节与相应申请的渥太华规则进行比较。记录中足或踝部骨折的情况。实施了多项干预措施以提高依从性；这包括分发第一次审核周期的结果以及向急诊科工作人员发放一份包含渥太华F&A规则的手册。在科室内部为急诊科初级医生举办了一次关于评估、记录和申请足踝损伤X光检查的教学课程。在实施上述干预措施三周后，完成了针对踝部和足部X光检查的相同的第二个回顾性审核周期。结果 渥太华足部规则在记录足部损伤方面的依从性从48%显著提高到78%（p <.001）。足部X光检查申请的依从性从32%显著提高到54%（p <.01）。踝部损伤的记录依从性从74%显著提高到87%（p <.05）。踝部损伤X光检查申请的依从性从43%提高到57%（p <.05）。骨折率没有显著变化；踝部骨折从17%增加到22%（p =.372），两个周期的足部骨折率均保持在15%。始终使用卡方检验评估显著性。结论 这个两周期的质量改进项目表明，伦敦南部一家医院在急诊科病历记录和X光检查申请临床细节方面对渥太华F&A规则的依从性有显著提高。遵守渥太华F&A规则有可能降低成本、加快出院速度并减少不必要的辐射暴露。
