Assessing Compliance With Ottawa Foot and Ankle Rules in the Emergency Department: A Closed-Loop Quality Improvement Project
Bibliographic record
Abstract
Introduction Traumatic foot and ankle injuries are frequent presentations to the emergency department (ED). The Ottawa Foot and Ankle (F&A) Rules are to help clinicians in decision making whether an X-ray of the foot or ankle is justified. Methods A retrospective analysis of ankle and foot X-ray requests from a South London Hospital ED was performed. Consecutive requests for both foot and ankle X-rays were assessed chronologically until n=100 for each cohort. The clinical documentation of each ED clerking and the X-ray request clinical details were then compared to the Ottawa Rules of that respective request. The presence of a midfoot or ankle fracture was recorded. Several interventions were implemented to improve compliance; this included distributing the results of the first audit cycle and a handout containing the Ottawa F&A rules to ED staff. A teaching session for ED Junior Doctors on assessing, documenting, and requesting X-rays for foot and ankle injuries was delivered within the department. An identical second retrospective audit cycle for both ankle and foot X-rays was then completed three weeks after implementation of the above interventions. Results The compliance of Ottawa Foot Rules in documenting foot injuries significantly improved from 48% to 78% (p<.001). Foot X-ray request compliance significantly improved from 32% to 54% (p<.01). Documentation compliance of ankle injuries significantly improved from 74% to 87% (p<.05). Ankle injury X-ray request compliance improved from 43% to 57% (p<.05). Fracture rate did not significantly change; ankle fractures increased from 17% to 22% (p=.372), foot fracture rate remained 15% in both cycles. Significance was assessed using the Chi-square test throughout. Conclusion This two-cycle Quality Improvement Project demonstrated significant improvement in compliance with Ottawa F&A Rules for ED clerking documentation and X-ray request clinical details in a South London Hospital. Compliance with Ottawa F&A Rules has the potential to reduce costs, facilitate faster discharge, and reduce unnecessary radiation exposure.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".