title: 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.
authors.affiliation: Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. brian.rowe@ualberta.ca
authors.forename: Brian R
authors.initials: BR
authors.lastname: Holroyd
authors.forename: Deborah
authors.initials: D
authors.lastname: Wilson
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Damon C
authors.initials: DC
authors.lastname: Mayes
authors.forename: Thomas
authors.initials: T
authors.lastname: Noseworthy
mesh_terms: D000328:Adult; D000416:Alberta; D016512:Ankle Injuries / Q000150:complications / Q000175:diagnosis*; D002985:Clinical Protocols / Q000592:standards; D003663:Decision Trees; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000193:education / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination; D007318:Inservice Training / Q000458:organization & administration; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology / Q000592:standards; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D011859:Radiography / Q000706:statistics & numerical data