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Fry M. Triage nurses order X-rays for patients with isolated distal limb injuries: A 12-month ED study. J Emerg Nurs 2001; 27(1):17-22.
Triage nurses can safely, accurately, and appropriately assess patients and order X-rays for patients with distal limb injuries before physician assessment, says this study from St. George Hospital in New South Wales, Australia. Triage nurses were educated on X-ray protocols, pain assessment, radiation safety information, and documentation guidelines. Over one year, triage nurses ordered 876 X-rays and physicians ordered 930, with equal proportions of upper and lower limb X-rays. The triage X-ray abnormality rate was 43%, and the medical staff abnormality rate was 33%.
These results show that the triage nurses ordered fewer X-rays than the physicians and with greater accuracy. The researcher speculates that this difference might be explained by the triage nurses’ need to identify positive clinical findings before ordering X-rays, while physicians often order X-rays based on suspicion.
By having their distal limb X-rays ordered as soon as the patients arrived in the ED, the film was available by the time the patient was seen by the physician, the researcher stated. "The early triage X-rays ordered by the nurse reduced frustration for both staff and patients," wrote the researcher. Although some triage nurses thought ordering X-rays slowed the triage process, all acknowledged the benefits of this practice. Additionally, the triage nurses reported an increase in clinical confidence and job satisfaction.
According to the study’s findings, the ED staff said this new triage practice increased patient satisfaction and improved patient flow and waiting times. "The ED personnel perceived that triage nurse-initiated X-rays assisted with the problem of aggressive patients frustrated with long waiting times," wrote the researcher.