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

      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.

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      References

        • Davis D.A
        • Taylor-Vaisey A
        Translating guidelines into practice. A systematic review of theoretic concepts, practical experiences and research evidence in the adoption of clinical practice guidelines.
        CMAJ. 1997; 157: 408-416
        • Lawrence R.S
        Diffusion of task force recommendations.
        J Intern Med. 1990; 5: S99-S103
        • Stiell I.G
        • Greenberg G.H
        • McKnight R.D
        • et al.
        Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation.
        JAMA. 1993; 269: 1127-1132
        • Stiell I.G
        • Wells G.W
        • Laupacis A
        • et al.
        • Multicentre Ankle Rule Study Group
        Multicentre trial to introduce the Ottawa Ankle Rules for use of radiography in acute ankle injuries.
        BMJ. 1995; 311: 594-597
        • Laupacis A
        • Sekar N
        • Stiell I.G
        Clinical prediction rules. A review and suggested modifications of methodological standards.
        JAMA. 1997; 277: 488-494
        • Markert R.J
        • Walley M.E
        • Guttman T.G
        • Mehta R
        A pooled analysis of the Ottawa Ankle Rules used on adults in the ED.
        Am J Emerg Med. 1998; 16: 564-567
        • McBride K.L
        Validation of the Ottawa Ankle Rules. Experience at a community hospital.
        Can Fam Physician. 1997; 43: 459-465
        • Auleley G.R
        • Ravaud P
        • Giraudeau B
        • et al.
        Implementation of the Ottawa Ankle Rules in France.
        JAMA. 1997; 277: 1935-1939
        • Verbeek P.R
        • Stiell I.G
        • Hebert G
        • Sellens C
        Ankle radiograph utilization after learning a decision rule.
        Acad Emerg Med. 1997; 4: 776-779
        • Stiell I.G
        • McKnight R.D
        • Greenberg G.H
        • et al.
        Implementation of the Ottawa Ankle Rules.
        JAMA. 1994; 271: 827-832
        • Wilson D.E
        • Noseworthy T.W
        • Rowe B.H
        • Holroyd B.R
        Evaluation of patient satisfaction and outcomes after assessment for acute ankle injuries.
        Am J Emerg Med. 2002; 20: 18-22
        • Stiell I.G
        • Wells G.A
        • McDowell I
        • et al.
        Use of radiography in acute knee injuries.
        Acad Emerg Med. 1995; 2: 966-973
        • Stiell I.G
        • Greenberg G.H
        • Wells G.A
        • et al.
        Prospective validation of a decision rule for the use of radiography in acute knee injuries.
        JAMA. 1996; 275: 611-612
        • Stiell I.G
        • Wells G.A
        • Vandemheen K
        • et al.
        The Canadian C-Spine Rule for radiography in alert and stable trauma patients.
        JAMA. 2001; 286: 1841-1848
        • Cameron C
        • Naylor C.D
        No impact from active dissemination of the Ottawa Ankle Rules.
        CMAJ. 1999; 160: 1165-1168
        • Cabana M.D
        • Rand C.S
        • Powe N.R
        • et al.
        Why don’t physicians follow clinical practice guidelines? A framework for improvement.
        JAMA. 1999; 282: 1458-1465
        • Graham I.D
        • Stiell I.G
        • Laupacis A
        • O’Connor A.M
        • Wells G.A
        Emergency physicians’ attitudes toward and use of clinical decision rules for radiography.
        Acad Emerg Med. 1998; 5: 134-140