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The number of consultations in emergency departments is increasing day by day, and the time to treat patients is getting longer. Different French studies have shown a significant reduction in the time spent in the emergency department after the implementation of the national protocol for the delegation of early radiography prescriptions. The investigators hypothesised that an early request for a standard X-ray by the intake and referral nurse in the case of isolated trauma to the extremities of a limb (from the knee to the toes and from the shoulder to the fingers) enables a reduction in medical management time and, consequently, in the time spent in the emergency department for the patient.
This study is divided into two steps to three month.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Current practice: radiography request by physician | Experimental | No interventions will be performed. There is no change in current practice. |
|
| Radiography request by the nurse | Experimental | the intake and referral nurse will request a radiography if required according to the local cooperation protocol |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Radiography request by nurse | Procedure | Intervention group with radiography requested by the IRN instead of the physician. The radiography will be interpreted by the physician afterwards, according to current practice |
| Measure | Description | Time Frame |
|---|---|---|
| Duration between triage and exit of emergency unit | Total duration in minutes in the emergency department with or without anticipated request of X-ray | immediatly after the procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Total duration of the stay | Total duration in minutes in the emergency department | immediatly after the procedure |
| Number of additional X-ray prescribed by the physician after physician assessment. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Vincent GARROUSTE, MD | Regional Hospital center of ORLEANS | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHR d'Orléans | Orléans | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 10718230 | Background | Lindley-Jones M, Finlayson BJ. Triage nurse requested x rays--are they worthwhile? J Accid Emerg Med. 2000 Mar;17(2):103-7. doi: 10.1136/emj.17.2.103. | |
| 40372320 | Derived | Garrouste V, Malcuit L, Muller G, Jouffroy R, Boulain T. Nurse-Initiated X-Ray Requests for Extremity Trauma in the Emergency Department: A Single-Center, Prospective, Before-and-After Cohort Study. J Emerg Nurs. 2025 Jul;51(4):587-596. doi: 10.1016/j.jen.2025.03.019. Epub 2025 May 14. |
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Radiography request by physician | Procedure | The physician prescribed the X-ray, the X-ray technician carries out the imagery and the physician interprets it afterwards |
|
Number of new X-ray images taken after physician assessment.
| immediatly after the procedure |
| Appropriateness of the X-rays requested by the IRN as per guidelines | Number of new X-ray images taken after physician assessment. | immediatly after the procedure |
| IRN's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire) | Quality of life questionnaire. Min: not satisfied; max : satisfied | immediatly after the procedure |
| X-ray technician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire) | Quality of life questionnaire. Min: not satisfied; max : satisfied | immediatly after the procedure |
| Physician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire) Physician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire) | Quality of life questionnaire. Min: not satisfied; max : satisfied | immediatly after the procedure |