Nurse-initiated radiographic-test protocol for ankle injuries: A randomized controlled trial

•Fewer ankle and foot radiographic tests were requested in protocol group.•More malleolar and midfoot fractures were detected in protocol group.•Length of stay was shortened in protocol group.•Waiting time from consultation to discharge was reduced in protocol group. Nurse-initiated radiographic-test protocol was compared with usual practice in reducing unnecessary ankle and foot radiographic-test requests and shortening patients’ length of stay (LOS) in an emergency department (ED) by reducing their waiting time for physician reassessment. Patients with ankle injuries were enrolled in an unblinded randomized controlled trial. Participants were randomized to receive either the protocol (n = 56) or usual practice (n = 56). Primary outcome was the proportion of radiographic-test requests. Secondary outcomes were the proportion of fractures detected and patients’ LOS and waiting times. The proportions of ankle and foot radiographic tests requested by triage nurses implementing the Ottawa Ankle Rules (OARs) in protocol group were smaller than those requested by physicians using their expertise in usual practice group. The proportions of malleolar and midfoot fractures detected by triage nurses implementing the OARs in protocol group were higher than those detected by physicians using their expertise in usual practice group. Patients’ LOS and waiting time from consultation to discharge in protocol group were shorter than those in usual practice group. Implementing the nurse-initiated radiographic-test protocol reduced unnecessary ankle and foot radiographic-test requests and shortened patients’ LOS in the ED by reducing their waiting time for physician reassessment.