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)

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).

Study Overview

• Status: Completed
• Conditions: Trauma Injury
• Intervention / Treatment: Diagnostic test: Nursing triage protocol

• Study Type: Interventional
• Enrollment (Actual): 220
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tom Van Zundert, PhD; Phone Number: 003214712000; Email: tom.vanzundert@azmol.be
• Study Contact Backup: Name: Filip Haegdorens, PhD; Email: filip.haegdorens@uantwerpen.be

Study Locations

• Belgium
  • Antwerp
    • Wilrijk, Antwerp, Belgium, 2610
      • University of Antwerp

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Nursing triage group; Using a triage protocol for medical imaging conducted by a triage nurse in the emergency department	Diagnostic test: Nursing triage protocol; 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.
No Intervention: Regular care group; Regular triage in the emergency department

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
TLOS	Total length of stay	6-8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient satisfaction	Patient satisfaction measured by a 10-point Likert scale at discharge using a questionnaire	6-8 weeks
Treatment efficiency	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.	6-8 weeks

Collaborators and Investigators

• Sponsor: Universiteit Antwerpen
• Collaborators: Heilig Hartziekenhuis, Mol
• Investigators: Principal Investigator: Filip Haegdorens, PhD, University of Antwerp, Belgium

Study record dates

Study Major Dates

• Study Start (Actual): March 6, 2023
• Primary Completion (Actual): April 23, 2023
• Study Completion (Actual): April 23, 2023

Study Registration Dates

• First Submitted: February 9, 2023
• First Submitted That Met QC Criteria: February 28, 2023
• First Posted (Actual): March 13, 2023

Study Record Updates

• Last Update Posted (Actual): July 3, 2023
• Last Update Submitted That Met QC Criteria: June 28, 2023
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies; Wounds and Injuries
• Other Study ID Numbers: TRINU-RX

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