Triage nurse–initiated X-ray radiography in minor trauma

Abstract

Background Overcrowding in paediatric emergencies departments is a worldwide issue, where improving the quality of care is a priority. The main objective of this study was to determine the effect of triage nurse-initiated X-ray radiography on length of stay in paediatric emergency admissions. Methods This retrospective, monocentric, descriptive study was performed in two successive 3-month periods: a pre-protocol (“before”) period from February 03, 2020 to May 03, 2020, and a protocol (“after”) period from May 04, 2020 to August 02, 2020, when patients underwent nurse-initiated X-ray radiography. The study involved all patients aged 3 years and over, valid, non-hyperalgic, accompanied by their parents, consulting for a simple closed distal trauma, involving a single limb segment or joint, in the paediatric emergency department. Results 695 patients were included, 298 in the first period and 397 in the second period. Median length of stay in the paediatric emergency department was significantly shorter during the second period (119 min [80; 165] vs. 80 min [60; 105], p < 0.001), i.e. a median reduction time of 39 minutes or 33% (effect size = −0.68, 95% CI [−0.84; −0.53]). Triage nurse requests were judged “adequate and sufficient” in 95.2% of cases with only 2.0% of instances deemed “unnecessary” by the medical team. In 2.8% of cases, “another X-ray” was required to support diagnosis. Conclusions The application of a triage nurse X-ray protocol significantly reduced length of stay in a paediatric emergency department. The quality of patient management remained unchanged and nurse requests were relevant.