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

NCT01785368 | Completed

• 2 other identifiers: LOCAL/2012/PR-012013-A00113-42
• Study Type: interventional
• Target: 8,549
• Locations: 1 country
• Sites: 1

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.

Conditions

Emergency Department Admission; Imaging Techniques

Keywords

guidelines; referral guidelines; exam delays; exam relevance

Outcome Measures

Primary Outcomes (1)

• Change in the % of initial, suspected diagnoses that are confirmed positive by the requested exam

  Measured over an observation period of 1 month.

  baseline (days 0 to 30) versus the 6th month after implementation of guidelines

Secondary Outcomes (17)

• 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

• 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

• Change in the positivity rate for each suspected diagnosis

  baseline (days 0 to 30) versus the 6th month after implementation of guidelines

• Change in the % of exams performed identical to the exam requested

  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.

  baseline (days 0 to 30) versus the 6th month after implementation of guidelines

Study Arms (2)

Before guideline implementation

OTHER

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

Other: Baseline observation

After guideline implementation

OTHER

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

Other: Implementation of guidelines

Interventions

Implementation of guidelines OTHER

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.

After guideline implementation

Baseline observation OTHER

During this period of the study, baseline data will be collected.

Before guideline implementation

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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).

You may not qualify if:

• The patient is under judicial protection
• The patient (or his/her guardian/parent/person-of-trust) refuses to participate in the study

Sponsors & Collaborators

• Centre Hospitalier Universitaire de Nīmes: lead

Study Sites (1)

CHU de Nîmes - Hôpital Universitaire Carémeau

Nîmes, 30029, France

Location

Related Publications (1)

• Claret PG, Bobbia X, Macri F, Stowell A, Motte A, Landais P, Beregi JP, de La Coussaye JE. Impact of a computerized provider radiography order entry system without clinical decision support on emergency department medical imaging requests. Comput Methods Programs Biomed. 2016 Jun;129:82-8. doi: 10.1016/j.cmpb.2016.03.006. Epub 2016 Mar 17.

  PMID: 27084323 RESULT

Study Officials

• Patrick Richard, MD

  Centre Hospitalier Universitaire de Nîmes

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 5, 2013
• First Posted: February 7, 2013
• Study Start: October 1, 2013
• Primary Completion: June 2, 2014
• Study Completion: June 2, 2014
• Last Updated: November 17, 2025

Record last verified: 2015-03

Locations

FR (1)