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Completed

NCT Number: NCT01785368

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

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.

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Key information

Conditions

Emergency Department Admission Imaging Techniques

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

CHU de Nîmes - Hôpital Universitaire Carémeau

Nîmes, 30029, France

About this study

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

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

Baseline observation

Other

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

Primary outcomes

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

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

    Measured over an observation period of 1 month.

Secondary outcomes

  1. Change in the classification of exam results in relation to initial, suspected diagnosis

    Time frame: 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.

  2. Change in the % of requested exams that do not conform with the exam recommended by the implemented guidelines

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

    Measured over an observation period of 1 month.

  3. Change in the positivity rate for each suspected diagnosis

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

    Measured over an observation period of 1 month.

  4. Change in the % of exams performed identical to the exam requested

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

    Measured over an observation period of 1 month.

  5. Change in the average delay between the time marked on the request and the exam.

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

    Measured over an observation period of 1 month.

  6. Change in the average delay between the time marked on the request and the distribution of written exam results.

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

    Measured over an observation period of 1 month.

  7. Change in the number of admissions in the emergency department

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

    Measured over an observation period of 1 month.

  8. Change in the number of requests for imaging exams made by the emergency department

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

    Measured over an observation period of 1 month.

  9. Change in the % of patients admitted to the emergency department and needing an imaging exam.

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

    Measured over an observation period of 1 month.

  10. Change in the frequency of each type of exam carried out.

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

    Measured over an observation period of 1 month.

  11. Change in the frequency of each type of clinical situation associated with imaging exams.

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

    Measured over an observation period of 1 month.

  12. Change in the average number of imaging exams requested per patient

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

    Measured over an observation period of 1 month.

  13. Change in the frequency of imaging exams requested per type of emergency situation

    Time frame: 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.

  14. Change in the % agreement between the clinical situation coded by the emergency doctor and the radiologist

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

    Measured over an observation period of 1 month.

  15. Change in the total radiation exposure per patient

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

    Measured over an observation period of 1 month.

  16. Change in the frequency of injection of contrast agents

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

    Measured over an observation period of 1 month.

  17. Change in the frequency of patients requiring contrast agents AND whose exam results are classified as "the suspected diagnosis was not confirmed, exam normal"

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

    Measured over an observation period of 1 month.

Sponsors and collaborators

Lead sponsor

Centre Hospitalier Universitaire de Nīmes

Other

Registry information

Official study title

Implementing Referral Guidelines for Imaging Exams Requested Via the Emergency Department: Impact on Exam Relevance and Associated Delays

Acronym: RIU

Important dates

Study start
2013
Primary completion
2014
Study completion
2014
First posted
Feb 7, 2013
Registry last updated
Nov 17, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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