Emergency Department Admission, Imaging Techniques
Conditions
Keywords
guidelines, referral guidelines, exam delays, exam relevance
Brief summary
The main objective of this study is to evaluate the impact of the implementation of referral guidelines for imaging exams requested by the emergency department on exam relevance. The latter is assessed via the rate of suspected diagnoses that are confirmed by the requested exam.
Detailed description
The secondary objectives of this study are to assess the impact of the implementation of referral guidelines for imaging exams requested by the emergency department on the following: A. How exam results are classified in relation to the initial, suspected diagnosis. B. Further aspects of exam relevance. C. Delays associated with exams D. Changes in practice in terms of type of examination, clinical situations, the number of tests ordered per patient, and emergency situations E. Radiation and contrast agent exposures
Interventions
The participating ER doctors are required to request imaging exams for their patients according to a guide mutually constructed by the emergency and imaging departments of the Nîmes university hospital.
OTHERBaseline observation
During this period of the study, baseline data will be collected.
Sponsors
Centre Hospitalier Universitaire de Nīmes
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* The patient (or his/her guardian/parent/person-of-trust) was correctly informed about the study * A participating ER doctor has requested an imaging exam for the patient during one of the trial observation periods (ie the before period or the after period).
Exclusion criteria
* The patient is under judicial protection * The patient (or his/her guardian/parent/person-of-trust) refuses to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in the % of initial, suspected diagnoses that are confirmed positive by the requested exam | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in the % of requested exams that do not conform with the exam recommended by the implemented guidelines | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the positivity rate for each suspected diagnosis | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the % of exams performed identical to the exam requested | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the average delay between the time marked on the request and the exam. | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the average delay between the time marked on the request and the distribution of written exam results. | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the number of admissions in the emergency department | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the number of requests for imaging exams made by the emergency department | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the % of patients admitted to the emergency department and needing an imaging exam. | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the classification of exam results in relation to initial, suspected diagnosis | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Qualitative variable: (i) the suspected diagnosis is confirmed; (ii) the suspected diagnosis was not confirmed, the exam was normal; (iii) the suspected diagnosis was confirmed, and another unsuspected pathology was also found; (iv) the suspected diagnosis was not confirmed, and another unsuspected pathology was found. Measured over an observation period of 1 month. |
| Change in the average number of imaging exams requested per patient | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the frequency of each type of clinical situation associated with imaging exams. | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the frequency of imaging exams requested per type of emergency situation | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | vital; imaging needed in 4 - 6 hours; imaging needed in 6 to 24h, scheduled for hospitalisation, external demand, social requirements Measured over an observation period of 1 month. |
| Change in the % agreement between the clinical situation coded by the emergency doctor and the radiologist | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the total radiation exposure per patient | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the frequency of injection of contrast agents | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the frequency of patients requiring contrast agents AND whose exam results are classified as the suspected diagnosis was not confirmed, exam normal | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
| Change in the frequency of each type of exam carried out. | baseline (days 0 to 30) versus the 6th month after implementation of guidelines | Measured over an observation period of 1 month. |
Countries
France
Outcome results
None listed