X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse:

Not Applicable

Completed

Interventions: Procedure: Radiography request by nurse
Procedure: Radiography request by physician

Brief Summary: The number of consultations in emergency departments is increasing day by day, and the time to treat patients is getting longer. Different French studies have shown a significant reduction in the time spent in the emergency department after the implementation of the national protocol for the delegation of early radiography prescriptions. The investigators hypothesised that an early request for a standard X-ray by the intake and referral nurse in the case of isolated trauma to the extremities of a limb (from the knee to the toes and from the shoulder to the fingers) enables a reduction in medical management time and, consequently, in the time spent in the emergency department for the patient.

Detailed Description: This study is divided into two steps to three month.

* The first step of the study corresponds to the current standard of care (SoC) in the emergency department of Orléans. In this first step, the intake and Referral Nurse (IRN) will carry out the usual triage and refer the participant to the appropriate emergency department before being appointed by the physician. The radiography will be requested after the medical consultation.

* In the second step, the intake and referral nurse will carry out the usual triage and then request one, or more, radiography(ies) depending on the standard protocol. This ensures that the physician has access to the imaging before the consultation with the patient. If necessary, the X-ray technician is authorized to refuse the exams or complete the request, the choice of the incidence is up to him/her according to the intake and referral nurse.

Recruitment & Eligibility

Inclusion Criteria

Patient older than 15 years and 3 months admitted in adult emergency department of regional hospital center of ORLEANS with a simple and isolated trauma having occurred less than 48 hours prior to admission of a limb extremity (from the knee to the toes or from the shoulder to the fingers), and with no previous imagery assessment within 48 hours prior to admission in the emergency department.

Exclusion Criteria

Multiple trauma
Patient with at least one Vittel criteria (except age)
Patient refusing the protocol
Hemodynamic instability and/or disorder of consciousness
Sensory and/or vascular disorders downstream of the traumatized area
Protected population (under guardianship or curators)
Patient under court protection
Pregnant or breastfeeding woman or one who declares herself to be pregnant or breastfeeding
Patient with an expired blood alcohol level > 0.4 mg/L and/or positive blood alcohol level
Patient with diagnosed dementia
Patient hospitalized after being taken in charge

Arm && Interventions

Group	Intervention	Description
Radiography request by the nurse	Radiography request by nurse	the intake and referral nurse will request a radiography if required according to the local cooperation protocol
Current practice: radiography request by physician	Radiography request by physician	No interventions will be performed. There is no change in current practice.

Primary Outcome Measures

Name	Time	Method
Duration between triage and exit of emergency unit	immediatly after the procedure	Total duration in minutes in the emergency department with or without anticipated request of X-ray

Secondary Outcome Measures

Name	Time	Method
IRN's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)	immediatly after the procedure	Quality of life questionnaire. Min: not satisfied; max : satisfied
Total duration of the stay	immediatly after the procedure	Total duration in minutes in the emergency department
X-ray technician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)	immediatly after the procedure	Quality of life questionnaire. Min: not satisfied; max : satisfied
Physician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire) Physician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)	immediatly after the procedure	Quality of life questionnaire. Min: not satisfied; max : satisfied
Appropriateness of the X-rays requested by the IRN as per guidelines	immediatly after the procedure	Number of new X-ray images taken after physician assessment.
Number of additional X-ray prescribed by the physician after physician assessment.	immediatly after the procedure	Number of new X-ray images taken after physician assessment.