The aim of this study was to systematically review the literature on the effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries. The review protocol was registered with PROSPERO and CINHAL, MEDLINE and EMBASE were searched for studies comparing nurse-initiated vs physician-initiated X-ray. Because of heterogeneity of patients, providers and outcomes, a meta-analysis was not performed. The 16 included studies were conducted between 1971 and 2018 and involved 8881 participants. There were four randomised trials and 12 observational studies that focussed on X-ray request accuracy (n = 14), emergency department processes (n = 6) and patient outcomes (n = 2). The quality of evidence for each outcome ranged from very low-to-moderate. Compared with physician-initiated X-ray, nurse-initiated X-ray uses no more resources, is safe and acceptable to patients. Nurse-initiated X-ray did not reduce time to X-ray or waiting time but in some studies, reduced emergency department length of stay and unplanned follow-up.
aSchool of Nursing and Midwifery, Centre for Quality and Patient Safety Research—Eastern Health Partnership, Deakin University, Geelong, Victoria, Australia
bWestern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
cIllawarra Shoalhaven Local Health District, The University of Sydney, New South Wales, Australia
dNorthern Sydney Local Health District, University of Technology Sydney, Sydney, New South Wales, Australia
Received 15 January 2019 Accepted 5 March 2019
Correspondence to Professor Julie Considine, RN, PhD School of Nursing and Midwifery and Centre for Quality and Patient Safety Research—Eastern Health Partnership, 3125 Deakin University, Geelong, Victoria, Australia, Tel: +61 3 9244 6127; e-mail: firstname.lastname@example.org