Implementation of the AWR by the ED triage nurse

In most hospitals, patients with wrist trauma are routinely referred for radiography of the wrist. However, only half of these patients have a fracture of the wrist. Currently, no clinical guidelines are imbedded in daily practice on Emergency Departments (ED) to decide if a wrist radiograph is necessary. This may result in unnecessary radiographs and therefore increased time spent at the ED, increased workload, and additional healthcare costs. Encouraged by the theoretical overuse of radiological resources due to the lack of clinical guidelines a clinical decision rule for both children and adults has been develop: the Amsterdam (Pediatric) Wrist Rules. The AWR and APWR have been externally validated and recently also implemented at the ED by emergency physicians. . However, in the recently finished implementation study, the EDs had to change their workflow because patients were first seen by the ED physician and not the triage nurse. Therefore, the aim of the current study is to evaluate the effect of the implementation of the Amsterdam Wrist Rules by ED triage nurses and to evaluate if this leads to the same reduction in wrist radiographs.

With implementation of the AWR and APWR by the ED triage nurse we expect a reduction in the total number of radiographs requested, without missing any clinical relevant fractures. We also expect a reduction in overall waiting times at the ED and cost savings.

Outcomes will be evaluated at the end of the inclusion period.

Use of the AWR and APWR