Abstract
This study examined whether emergency physicians (EPs) exposed to multiple dissemination strategies for the Ottawa Ankle Rules (OARs) would reduce extremity radiography use. We conducted a prospective cohort study comparing intervention (n = 2) with control (n = 2) hospitals over a 2-year period. All EPs received the paper-based rules during the run-in phase; EPs in the intervention hospitals were also subjected in sequence to valid dissemination approaches. Provincewide dissemination of the OARs did not decrease radiography during the run-in period (92% vs. 93%; P =.36). Sequential directed education and personalized feedback strategies failed to reduce radiographic ordering rates (P =.54) or the ordering of both foot and ankle radiographs (P =.11) over time. The use of radiography did not decrease despite the use of a variety of dissemination strategies. Additional research is required to determine the most effective methods of incorporating guidelines into emergency practice.
Publication types
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Clinical Trial
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Controlled Clinical Trial
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Multicenter Study
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Alberta
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Ankle Injuries / complications
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Ankle Injuries / diagnosis*
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Clinical Protocols / standards
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Decision Trees
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Education, Medical, Continuing / organization & administration*
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Emergency Medicine / education
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Emergency Medicine / standards*
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Emergency Medicine / statistics & numerical data
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Evidence-Based Medicine / education
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Evidence-Based Medicine / organization & administration
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Female
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Follow-Up Studies
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Guideline Adherence / standards*
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Guideline Adherence / statistics & numerical data
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Humans
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Information Dissemination
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Inservice Training / organization & administration
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Male
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Medical Staff, Hospital* / education
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Medical Staff, Hospital* / psychology
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Medical Staff, Hospital* / standards
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Middle Aged
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Practice Guidelines as Topic*
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Practice Patterns, Physicians' / standards*
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Practice Patterns, Physicians' / statistics & numerical data
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Program Evaluation
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Prospective Studies
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Radiography / statistics & numerical data