TORONTO — Your son pulled his elbow while playing with his friends. Would you want a nurse to treat the injury within minutes of arriving at the emergency room or wait for three hours for a doctor to help you?
A new Canadian study suggests that triage nurses can fix common arm injuries in children. And they can do it much faster — in about 10 minutes upon hospital arrival compared to hours of waiting for a doctor to conduct the same procedure.
If nurses take on this task, it could cut down on wait times and even free up valuable emergency room resources, according to lead author Dr. Andrew Dixon.
“It’s a question of efficiencies. It’s a fairly common injury that you can actually treat right away and the kids feel better almost immediately,” he told Global News. Dixon is a pediatrician and researcher at the University of Alberta.
“We knew just by experience that nurses are good at identifying who these kids are. If we could get them to the next step, to teach them to fix it as well, the kids would be treated within 10 minutes,” Dixon said.
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He’s talking about pulled elbows — or radial-head subluxation injuries — which is when your bone slips out of its normal position and dislocates. And it’s a common injury among youth — at the Children’s Hospital of Eastern Ontario, where Dixon conducted his clinical trial, there were more than 400 of these injuries each year.
Dixon says he’s treated hundreds of pulled elbows in children. Sometimes kids play with their siblings or friends and pull their elbow. In other instances, parents accidentally pull on their kids’ arms, like an “instinctive yank” if their child is about to fall, and the injury occurs.
“So parents have a lot of guilt because they often come in feeling like they’ve broken their child’s arm. We can make their arm better, and reassure them it’s common and not serious instead of waiting for three hours wondering what they’ve done,” Dixon said.
At CHEO, his team trained about 60 triage nurses on how to spot the injury and how to treat it. Over the course of about seven months, the nurses took on about 124 pulled elbows. Eighty-five per cent of the time they were successful; for doctors it was 97 per cent of the time.
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Dixon consulted with emergency department officials across the country and set the trial’s target: they were hoping nurses would have a success rate within a 10 per cent margin of doctors.
“We were a little bit (disappointed),” Dixon told Global News. But he said that because there were 60 nurses, they only had one or two opportunities each to fix a broken arm.
“They didn’t have a lot of practical time to get comfortable with the procedure and over time, as they get more experienced, they’ll get better at it,” he said.
But they were faster: the injury was treated within the first 10 minutes of showing up and families were out of hospital within 55 minutes compared to a two- or three-hour wait for a doctor.
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Triage nurses are the frontline health care workers when you arrive at the emergency department. Right now, triage nurses in Canada can treat pain, fever, and provide over-the-counter medication, among other responsibilities. They can also initiate treatment for asthma or order X-rays for example. CHEO and another children’s hospital in Alberta are the only sites that allow triage nurses to handle pulled elbows.
But that could change. It’s happening in other aspects of health care: pharmacists are now prescribing or taking away medication, ordering and interpreting lab results and even doling out flu shots in some provinces, for example.
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“As ERs get busier, which they have done over the last few years, people will be waiting longer for things like this,” Dixon said.
For now, CHEO nurses are still treating pulled elbows and Dixon is monitoring the work for quality assurance. Ultimately, he thinks triage nurses in children’s hospitals could have their roles expanded to treat this injury.
Dixon’s findings were published Monday in the Canadian Medical Association Journal.
carmen.chai@globalnews.ca
Follow @Carmen_Chai
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