1. Uptake of validated clinical practice guidelines: experience with implementing the Ottawa Ankle Rules.
- Author
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Holroyd BR, Wilson D, Rowe BH, Mayes DC, and Noseworthy T
- Subjects
- Adult, Alberta, Ankle Injuries complications, Clinical Protocols standards, Decision Trees, Emergency Medicine education, Emergency Medicine statistics & numerical data, Evidence-Based Medicine education, Evidence-Based Medicine organization & administration, Female, Follow-Up Studies, Guideline Adherence statistics & numerical data, Humans, Information Dissemination, Inservice Training organization & administration, Male, Middle Aged, Practice Patterns, Physicians' statistics & numerical data, Program Evaluation, Prospective Studies, Radiography statistics & numerical data, Ankle Injuries diagnosis, Education, Medical, Continuing organization & administration, Emergency Medicine standards, Guideline Adherence standards, Medical Staff, Hospital education, Medical Staff, Hospital psychology, Medical Staff, Hospital standards, Practice Guidelines as Topic, Practice Patterns, Physicians' standards
- 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.
- Published
- 2004
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