Increasing Utilization of the Ottawa Ankle Rules in the Urgent Care Setting

The Ottawa Ankle Rules (OAR) have not been efficiently utilized in the urgent care setting. Even though multiple studies support providers in understanding the use of these tools for clinical decision making, clinicians continue to underutilize these tools. This quality improvement study was aimed at understanding the reason for the underutilization of the OAR. Several articles were examined in support of and against the OAR; the consensus was, the OAR do serve as a reliable decision making tool. Therefore, a quality improvement study was constructed to increase the utilization of the OAR by providers and clinical staff, in a busy urgent care setting. Staff were educated through a PowerPoint presentation and individual verbal education. Providers were offered one-on-one education and given a recent meta analyses by Beckencamp et al. (2016) which analyzed 66 studies supporting the use of the OAR. In addition, posters were placed in the provider's office as a persistent reminder of the OAR. Pre- and post-surveys studied the knowledge of OAR, the use of OAR and feelings about the OAR; these were answered by clinical staff and providers. The surveys measured whether the underutilization of these rules were due to lack of knowledge or clinician perception. The results showed that clinical staff were not educated on the OAR, and once educated increased their use of these clinical tools. Whereas, the providers were overall knowledgeable of the tools, but felt they were not a useful tool in the urgent care setting. Overall, this project was effective at increasing clinical use of the OAR, however, did not decrease unnecessary ankle radiographs as anticipated. Further investigation into provider attitude and barriers in using the OAR over x-ray, when indicated, would be a beneficial extension of this quality improvement project.