Referral Guidelines for Imaging Exams: Impact on Exam Relevance and Associated Delays (RIU)

Centre Hospitalier Universitaire de Nīmes

Status: Completed

Conditions: Emergency Department Admission; Imaging Techniques

Treatments: Other: Implementation of guidelines; Other: Baseline observation

Study type: Interventional

Funder types: Other

Identifiers

NCT01785368

LOCAL/2012/PR-01

Details and patient eligibility

About

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.

Full 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

Enrollment: 8,549 patients

Sex: All

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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8,549 participants in 2 patient groups

Before guideline implementation

Other group

Description:

This study population consists of all patients for whom a participating ER doctor requests an imaging exam during the observation period BEFORE the implementation of the referral guidelines. \[This study is composed of (1) a period of observation for 1 month BEFORE the implementation of the referral guidelines, followed by (2) the implementation of the referral guidelines, then (3) a 5-6 month washout period, and finally (4) a 1 month observational period AFTER the implementation of the referral guidelines.\] Intervention: Baseline observation

Treatment:

Other: Baseline observation

After guideline implementation

Other group

Description:

This study population consists of all patients for whom a participating ER doctor requests an imaging exam during the observation period AFTER the implementation of the referral guideline. \[This study is composed of (1) a period of observation for 1 month BEFORE the implementation of the referral guidelines, followed by (2) the implementation of the referral guidelines, then (3) a 5-6 month washout period, and finally (4) a 1 month observational period AFTER the implementation of the referral guidelines.\] Intervention: Implementation of guidelines

Treatment:

Other: Implementation of guidelines