• G J Packer, C C Goring, A D Gayner, and A D Craxford.
• North Tyneside General Hospital, North Shields, Wear.
• BMJ. 1991 Apr 13; 302 (6781): 885-7.

ObjectiveTo 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.DesignThe 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.SettingAccident and emergency department of a district general hospital.Patients550 patients attending the department with ankle injuries over four months.ResultsThe 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).ConclusionsUsing a protocol can, at little expense, improve the treatment of ankle injuries and reduce the cost of radiology in an accident and emergency department.ImplicationTreatment of other conditions may be improved by introducing a protocol.

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