4. STANDARD: ANKLE AND FOOT X-RAYS FOR EMERGENCY DEPARTMENT PATIENTS WITH ACUTE TRAUMATIC ANKLE INJURIES
A. Clinical studies and medical literature reveal x-rays are not immediately required on patients presenting with some acute injuries or illness. The following x-rays are not routinely indicated in patients with a reliable history and physical exam:
(1) Criteria for not Obtaining Routine Ankle x-rays.
a. Age 18 or older;
b. No known bone disease;
c. No other significant painful injuries;
d. Able to bear weight immediately after injury and take four steps in the ED (regardless of limping);
e. No obvious bony deformity;
f. only mild swelling; and,
g. No tenderness of posterior edge or tip of either malleolus.
(2) Associated x-rays
a. Routine Foot x-rays for Ankle Injuries are not indicated.
b. Stress Films of the ankle are not indicated in the acute setting.
B. Discharge instructions: When the emergency medical provider determines a patient may be discharged, written instructions must be documented on the emergency department medical record and signed by the patient. The instructions should include all of the following, as appropriate:
(1) specific advice regarding recommended treatment and/or medications relating to the patient's clinical problem;
(2) information about follow-up, if needed, which includes the name of an appropriate physician and/or clinic and a suggested time period in which the patient should 'be seen;
(3) Instructions to call or return to the Emergency Department if symptoms progress/persist or if the patient encounters difficulty in implementing the suggested follow-up plans.
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