X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse: (DARIO)

X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse: X-TRAIN Study

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.

Study Overview

• Status: Completed
• Conditions: Limb Injury
• Intervention / Treatment: Procedure: Radiography request by physician; Procedure: Radiography request by nurse

Detailed Description

This study is divided into two steps to three month.

• The first step of the study corresponds to the current standard of care (SoC) in the emergency department of Orléans. In this first step, the intake and Referral Nurse (IRN) will carry out the usual triage and refer the participant to the appropriate emergency department before being appointed by the physician. The radiography will be requested after the medical consultation.
• In the second step, the intake and referral nurse will carry out the usual triage and then request one, or more, radiography(ies) depending on the standard protocol. This ensures that the physician has access to the imaging before the consultation with the patient. If necessary, the X-ray technician is authorized to refuse the exams or complete the request, the choice of the incidence is up to him/her according to the intake and referral nurse.

• Study Type: Interventional
• Enrollment (Actual): 400
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Orléans, France
    • CHR d'Orléans

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 80 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient older than 15 years and 3 months admitted in adult emergency department of regional hospital center of ORLEANS with a simple and isolated trauma having occurred less than 48 hours prior to admission of a limb extremity (from the knee to the toes or from the shoulder to the fingers), and with no previous imagery assessment within 48 hours prior to admission in the emergency department.

Exclusion Criteria:

• Multiple trauma
• Patient with at least one Vittel criteria (except age)
• Patient refusing the protocol
• Hemodynamic instability and/or disorder of consciousness
• Sensory and/or vascular disorders downstream of the traumatized area
• Protected population (under guardianship or curators)
• Patient under court protection
• Pregnant or breastfeeding woman or one who declares herself to be pregnant or breastfeeding
• Patient with an expired blood alcohol level > 0.4 mg/L and/or positive blood alcohol level
• Patient with diagnosed dementia
• Patient hospitalized after being taken in charge

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Current practice: radiography request by physician; No interventions will be performed. There is no change in current practice.	Procedure: Radiography request by physician; The physician prescribed the X-ray, the X-ray technician carries out the imagery and the physician interprets it afterwards
Experimental: Radiography request by the nurse; the intake and referral nurse will request a radiography if required according to the local cooperation protocol	Procedure: Radiography request by nurse; 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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	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.	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

Collaborators and Investigators

• Sponsor: Centre Hospitalier Régional d'Orléans
• Investigators: Principal Investigator: Vincent GARROUSTE, MD, Regional Hospital center of ORLEANS

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): January 16, 2023
• Primary Completion (Actual): June 25, 2023
• Study Completion (Actual): June 25, 2023

Study Registration Dates

• First Submitted: December 12, 2022
• First Submitted That Met QC Criteria: December 29, 2022
• First Posted (Actual): December 30, 2022

Study Record Updates

• Last Update Posted (Actual): August 1, 2023
• Last Update Submitted That Met QC Criteria: July 31, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: emergency department; Traumatology; Radiography; Personnel delegation; Nurse specialists; intake and referral nurse
• Other Study ID Numbers: CHRO-2022-08

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No