title: Does nurse-led initiation of Ottawa ankle rules reduce ED length of stay?
abstract: BACKGROUND
  Ankle injuries can account for up to 3.8% of UK Emergency Department (ED) presentations per annum and this figure is comparative to the 4.4% in North America. Growing ED attendance impacts on crowding, waiting times, patient satisfaction and service provision. One way to streamline service would be widespread use of the Ottawa Ankle Rules (OAR), which reduces the need to wait for radiography.
  
  
  OBJECTIVE
  To examine the best available evidence on the impact of OAR on ED length of stay (LoS) following standard systematic review methodology.
  
  
  METHODS
  A systematic search was undertaken in the CINAHL, EMBASE, MEDLINE, SCOPUS, and BNI databases. Studies that examined OAR use in the ED adult population were considered. Four studies met the inclusion criteria and were included in the narrative synthesis.
  
  
  RESULTS
  All four studies point towards a reduction in LoS following OAR introduction. The quality of the body of evidence is considered to be low due to moderate risk of bias and indirectness between the studies.
  
  
  CONCLUSIONS
  A strong body of evidence supports OAR use in reducing radiography but further research is needed to explore impact on LoS. This would inform clinical practice and potentially combat current pressures faced within EDs worldwide.
authors.affiliation: Department of Clinical Education, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, James Clerk, Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom. Electronic address: sarah.1.curr@kcl.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Curr
authors.affiliation: Department of Adult Nursing, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, James Clerk, Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
authors.forename: Andreas
authors.initials: A
authors.lastname: Xyrichis
mesh_terms: D016512:Ankle Injuries / Q000451:nursing*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D013180:Sprains and Strains / Q000451:nursing*
keywords: Ankle injuries; Emergency department; Length of stay; Ottawa ankle rules; Review; Systematic review