Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

Desai, S.; Liu, Chaocheng; Kirkland, Scott W.; Krebs, L.; Keto‐Lambert, Diana; Rowe, Brian H.

doi:10.1111/acem.13364

Cited by 12 publications

(11 citation statements)

References 38 publications

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“…While research on interventions to reduce low-value care, in general, recommend implementation of multi-component interventions in complex health care systems [ 12 , 25 – 28 ] there is still uncertainty as to why or when an intervention will be effective in diagnostic imaging specifically and/or in which clinical circumstances they are effective. Earlier systematic reviews on interventions in imaging have addressed specific interventions as image sharing or clinical decision support systems or specific imaging examinations or patient complaints [ 26 , 29 – 32 ]. However, there is no encompassing systematic review assessing the outcome of various types of interventions to reduce low-value imaging.…”

Section: Introductionmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

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Section: Introductionmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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“…The implementation of these strategies, however, has resulted in mixed results on the their effectiveness. For example, efforts exist to reduce low-value CT imaging for specific conditions such as low back pain and cervical spine injuries, and there are a number of clinical decision rules for CT use in the ED [ 20 - 22 ]. However, these studies have reported mixed results in terms of impact, and there is a lack of clarity about which specific implementation strategies are most effective for achieving reductions in low-value CT imaging.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department

Elzinga¹,

Dunne²,

Vorobeichik³

et al. 2020

Cureus

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This study describes the protocol for a systematic review and meta-analysis. The primary objective of the review is to identify experimental studies assessing the effectiveness of interventions that aim to reduce the proportion of computed tomography (CT) in emergency departments (EDs). Data permitting, our secondary objectives will be to assess the impact of reduction in CT utilization on the length of stay, admission to hospital, and uptake/satisfaction with the intervention. When available, balancing measures such as readmission to hospital or ED revisit rates will be included. Pre-defined subgroup analyses include patient populations (adult or pediatric), type of ED, and the nature of the intervention. Through this review, the research team aims to inform knowledge translation initiatives aimed at lowering CT usage in the ED by identifying the most effective interventions to safely improve CT resource stewardship.

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“…Twenty-three reviews examined interventions relating to process re-design. Processes that have been re-designed included clinical guidelines and protocols [25,31,[34][35][36], patient assignment and referral processes [4,31,[36][37][38], organisational processes (e.g., communication, administration) [19,25,35,39,40], nurseinitiated care processes [8,17,21,[41][42][43][44], clinical decision supports [45][46][47], and lean management/ lean thinking interventions [48][49][50]. A description of the characteristics for each type of process re-design intervention is provided in Table 3.…”

Section: Process Re-designmentioning

confidence: 99%

“…Clinical decision supports refers to the use of a validated clinical decision rule to assess the pre-test probability of the diagnosis [45,46] or tool to assess the need for diagnostic investigations [47]. For example, tools to assess the need for imaging in adult patients include the National X-radiography Utilization Study (NEXUS) criteria, and the Canadian C-Spine Rule (CCR [47];).…”

Section: Clinical Decision Supportsmentioning

confidence: 99%

Strategies to measure and improve emergency department performance: a scoping review

Austin

Blakely

Tufănaru

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs' capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. Methods and findings: We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies' titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients' decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. Conclusions: ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.

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Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

Cited by 12 publications

References 38 publications

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department

Strategies to measure and improve emergency department performance: a scoping review

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