Uptake of validated clinical practice guidelines: experience with implementing the Ottawa Ankle Rules

Am J Emerg Med. 2004 May;22(3):149-55. doi: 10.1016/j.ajem.2004.02.002.

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

  • Clinical Trial
  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alberta
  • Ankle Injuries / complications
  • Ankle Injuries / diagnosis*
  • Clinical Protocols / standards
  • Decision Trees
  • Education, Medical, Continuing / organization & administration*
  • Emergency Medicine / education
  • Emergency Medicine / standards*
  • Emergency Medicine / statistics & numerical data
  • Evidence-Based Medicine / education
  • Evidence-Based Medicine / organization & administration
  • Female
  • Follow-Up Studies
  • Guideline Adherence / standards*
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Information Dissemination
  • Inservice Training / organization & administration
  • Male
  • Medical Staff, Hospital* / education
  • Medical Staff, Hospital* / psychology
  • Medical Staff, Hospital* / standards
  • Middle Aged
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Program Evaluation
  • Prospective Studies
  • Radiography / statistics & numerical data