Evaluating the Impact of Audits and Re-audits on Adherence to the Ottawa Knee Rules in a High-Volume UK Trauma Centre.

Background The Ottawa Knee Rules (OKR) are a validated clinical decision-making tool designed to minimise unnecessary radiographs in knee trauma, thereby reducing radiation exposure, optimising resource utilisation, and streamlining patient management. This study audits and re-audits the clinical compliance with OKR in radiography referrals by the Orthopaedic and Emergency Department (ED) teams at Salford Royal NHS Foundation Trust. Methodology A two-cycle retrospective audit was conducted, examining knee X-ray request forms submitted between October 2023 and March 2024 (Cycle 1) and March 2024 and September 2024 (Cycle 2). Each request was evaluated against the OKR criteria and cross-referenced with corresponding clinical notes. Target compliance was 100%. Educational interventions were implemented after Cycle 1 to improve adherence. Results In Cycle 1, only 41% of referrals documented at least one OKR criterion. This improved significantly to 91% in Cycle 2. Notable improvements were observed in specific OKR indicators, including documentation of inability to bear weight (14% to 57%) and isolated patellar tenderness (13% to 72%). Conclusions Educational interventions substantially improved OKR compliance among ED and Orthopaedic staff. Sustained efforts, including regular training and audits, are essential to maintain adherence, reduce unnecessary imaging, and ensure high-quality patient care.