A Nursing Triage Protocol for Minor Orthopedic Traumata: the Effect on Flow Time, Quality of Care and Patient Satisfaction in an Emergency Department (TRINU-RX)

A Nursing Triage Protocol for Minor Orthopedic Traumata: the Effect on Flow Time, Quality of Care and Patient Satisfaction in an Emergency Department

A Nursing Triage Protocol for Minor Orthopedic Traumata: the Effect on Flow Time, Quality of Care and Patient Satisfaction in an Emergency Department

In 2019, nearly half of all hospital contacts in Belgium took place through the emergency department, and more than a third of patients arrived after an accident or trauma. In instances of overcrowding, patients with minor orthopedic injuries face prolonged waiting times. Previous studies have shown that implementing triage protocols for medical imaging conducted by a triage nurse can reduce the Total Length of Stay (TLOS) for this patient group. This is a single-center, unblinded, randomized, controlled trial that aims to evaluate the impact of a nurse triage protocol on turnaround time (primary outcome), quality of care, and patient satisfaction. The study population consists of adults who present with minor orthopedic injuries below the elbow or knee and have an Emergency Severity Index (ESI) of 4 or 5. Participants are randomly assigned to either the 'nurse triage protocol' group (n=110) or the 'usual care' group (n=110).

Medically approved and supervised standing order that allows trained ER nurses to start medical imaging (RX) for adult patients with minor traumata to the limbs.

Measurement if the patient diagnosis and/or treatment was correctly initiated at the Emergency Department. Yes = no additional diagnosis or treatments were necessary; No = within 14 days after discharge a change in treatment or new diagnosis was done. Data will be collected using the hospital's patient records or by calling patients if no information is found in the record.

Inclusion Criteria: Adults (18 years old) ESI 4 or ESI 5 Recent trauma (< 10 days after trauma) Accidental trauma mechanism Trauma below the elbow (forearm, wrist, hand, finger) Trauma below the knee (lower leg, ankle, foot, toe) Exclusion Criteria: ESI 1 or ESI 2 or ESI 3 Return visit after previous emergency department contact for the same injury (e.g. increased pain, tight cast, ...) Trauma resulting from underlying somatic pathology (e.g. syncope, epileptic attack, vertigo, vasovagal collapse, ...) Atraumatic (pain) complaints (e.g. pain in the calf, toe, foot, wrist, ... without a clear trauma mechanism) Additional, non-orthopedic injuries (e.g. laceration, signs of cerebral commotion, ...) Pregnancy or a suspicion of pregnancy