• Brian R Holroyd, Deborah Wilson, Brian H Rowe, Damon C Mayes, and Thomas Noseworthy.
• Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. brian.rowe@ualberta.ca
• Am J Emerg Med. 2004 May 1; 22 (3): 149-55.

AbstractThis study examined whether emergency physicians (EPs) exposed to multiple dissemination strategies for the Ottawa Ankle Rules (OARs) would reduce extremity radiography use. We conducted a prospective cohort study comparing intervention (n = 2) with control (n = 2) hospitals over a 2-year period. All EPs received the paper-based rules during the run-in phase; EPs in the intervention hospitals were also subjected in sequence to valid dissemination approaches. Provincewide dissemination of the OARs did not decrease radiography during the run-in period (92% vs. 93%; P =.36). Sequential directed education and personalized feedback strategies failed to reduce radiographic ordering rates (P =.54) or the ordering of both foot and ankle radiographs (P =.11) over time. The use of radiography did not decrease despite the use of a variety of dissemination strategies. Additional research is required to determine the most effective methods of incorporating guidelines into emergency practice.

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