Clinical trial NCT01785368: Referral Guidelines for Imaging Exams: Impact on Exam Relevance and Associated Delays
Official title: Implementing Referral Guidelines for Imaging Exams Requested Via the Emergency Department: Impact on Exam Relevance and Associated Delays
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Emergency Department Admission
Imaging Techniques
Keywords: guidelines
referral guidelines
exam delays
exam relevance
Lead sponsor: Centre Hospitalier Universitaire de Nīmes
Sponsor class: OTHER
First posted: 2013-02-07
Enrollment: 8549
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

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

Eligibility criteria: 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

Primary outcomes:
measure: Change in the % of initial, suspected diagnoses that are confirmed positive by the requested exam
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Secondary outcomes:
measure: Change in the classification of exam results in relation to initial, suspected diagnosis
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the % of requested exams that do not conform with the exam recommended by the implemented guidelines
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the positivity rate for each suspected diagnosis
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the % of exams performed identical to the exam requested
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the average delay between the time marked on the request and the exam.
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the average delay between the time marked on the request and the distribution of written exam results.
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the number of admissions in the emergency department
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the number of requests for imaging exams made by the emergency department
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the % of patients admitted to the emergency department and needing an imaging exam.
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the frequency of each type of exam carried out.
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the frequency of each type of clinical situation associated with imaging exams.
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the average number of imaging exams requested per patient
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the frequency of imaging exams requested per type of emergency situation
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the % agreement between the clinical situation coded by the emergency doctor and the radiologist
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the total radiation exposure per patient
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the frequency of injection of contrast agents
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
measure: Change in the frequency of patients requiring contrast agents AND whose exam results are classified as "the suspected diagnosis was not confirmed, exam normal"
timeFrame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Other outcomes:
Locations:
city: Nîmes Cedex 09
country: France
facility: CHU de Nîmes - Hôpital Universitaire Carémeau
Study officials:
affiliation: Centre Hospitalier Universitaire de Nîmes
name: Patrick Richard, MD
role: PRINCIPAL_INVESTIGATOR
References: