Effect of an algorithm on the treatment of knee injuries.

An audit was performed of the treatment of patients presenting with acute knee injuries to the accident and emergency department of a district general hospital. This showed that for patients requiring follow-up the majority were reviewed by the casualty officers themselves in the accident department, with the result that definitive diagnosis and treatment for patients with continuing symptoms was often delayed. Once the current treatment had been discussed at an audit meeting, a protocol (in the form of an algorithm) of the treatment of knee injuries was produced. A further audit was performed after the protocol had been in use. This demonstrated that the protocol was effective in encouraging the casualty officers to seek the help of more senior members of staff and also reduced the time taken to definitive diagnosis and treatment.

Audit of ankle injuries in an accident and emergency department.

OBJECTIVE: To determine whether the treatment of ankle injuries in an accident and emergency department could be improved by an audit of existing treatment and the creation and use of a protocol. DESIGN: The study consisted of three parts: a review of the current treatment and published reports on treatment, the formation of a protocol, and a study of treatment after introducing the protocol. SETTING: Accident and emergency department of a district general hospital. PATIENTS: 550 patients attending the department with ankle injuries over four months. RESULTS: The review of treatment showed that patients with fractures were detected and treated adequately, but most had radiography. Patients with ligamentous injuries may have been undertreated. After introducing the protocol the number of patients undergoing radiography was reduced from 205 (80%) to 186 (70%) (0.0027 less than p less than 0.01). In 87% of the notes reviewed the protocol had been completed. Sixty six patients with ligamentous injuries were reviewed in the department or soft tissue clinic compared with 20 before the protocol was introduced. There was a 53% reduction in inappropriate referrals to the fracture clinic (13 before v nine after). CONCLUSIONS: Using a protocol can, at little expense, improve the treatment of ankle injuries and reduce the cost of radiology in an accident and emergency department. IMPLICATION: Treatment of other conditions may be improved by introducing a protocol.