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.
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
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
8,549
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.
During this period of the study, baseline data will be collected.
CHU de Nîmes - Hôpital Universitaire Carémeau
Nîmes, France
Change in the % of initial, suspected diagnoses that are confirmed positive by the requested exam
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the classification of exam results in relation to initial, suspected diagnosis
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.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the % of requested exams that do not conform with the exam recommended by the implemented guidelines
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the positivity rate for each suspected diagnosis
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the % of exams performed identical to the exam requested
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the average delay between the time marked on the request and the exam.
Measured over an observation period of 1 month.
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Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the average delay between the time marked on the request and the distribution of written exam results.
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the number of admissions in the emergency department
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the number of requests for imaging exams made by the emergency department
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the % of patients admitted to the emergency department and needing an imaging exam.
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the frequency of each type of exam carried out.
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the frequency of each type of clinical situation associated with imaging exams.
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the average number of imaging exams requested per patient
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the frequency of imaging exams requested per type of emergency situation
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.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the % agreement between the clinical situation coded by the emergency doctor and the radiologist
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the total radiation exposure per patient
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the frequency of injection of contrast agents
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines
Change in the frequency of patients requiring contrast agents AND whose exam results are classified as "the suspected diagnosis was not confirmed, exam normal"
Measured over an observation period of 1 month.
Time frame: baseline (days 0 to 30) versus the 6th month after implementation of guidelines