Identifying Barriers and Facilitators to the Implementation of Radiation-Free Imaging Protocols in the Emergency Department

项目摘要/摘要 腹痛是急诊科患者最常见的主诉。这个 对这些患者的评估经常涉及到医学成像的使用。计算机断层扫描(CT)是由 是这一适应症最广泛使用的成像手段，但会使患者暴露在 他们有患癌症的风险。用于CT扫描的静脉造影剂也是已知的引起 肾损伤，导致透析甚至死亡。其他成像测试，包括磁共振 磁共振成像(MRI)和超声(US)对于检测腹痛的紧急原因和 不要将患者暴露在致癌辐射或损害肾脏的造影剂中。虽然指导方针 提倡使用US和MRI而不是CT的存在，医生们并没有常规地遵循它们。这个K08 提案将评估在急诊科使用US和MRI的障碍和促进者。 Repplinger博士是威斯康星大学麦迪逊分校的助理教授，有一项主要任命 在BerbeeWalsh急诊科和在 放射学。他的研究重点是评估CT的无辐射成像替代品，特别是使用 核磁共振检查。这项调查非常成功，这要归功于他在组装和 维护一支由具有医学物理学、紧急护理、 放射学、卫生服务研究以及他独特的资历。来自此3年期K08的支持 该奖项将为雷普林格博士提供必要的专门时间，以成功完成他提出的 研究项目。此外，他将能够从事职业发展活动，这将显著 加快他成为独立调查员的进程。 建议的目标是：1)确定高影响障碍和促进者，以遵守指南使用MRI和 美国在ED；2)设计针对高冲击障碍的候选干预捆绑包，并使用 来自关键利益相关者的输入；以及3)测试候选干预捆绑包对形象测试的影响 小儿阑尾炎的指南依从性。这些目标将使用混合方法来实现 方法：对目标1和目标2的焦点群体和来自我们电子健康的管理数据进行定性分析 为AIM 3创造记录。

PROJECT SUMMARY / ABSTRACT Abdominal pain is the single most frequent complaint for patients seen in the emergency department. The evaluation of these patients frequently involves the use of medical imaging. Computed tomography (CT) is by far the most widely used imaging modality for this indication, but exposes patients to levels of radiation that put them at risk for developing cancer. The intravenous contrast agent used for CT scans is also known to cause kidney injury, leading to dialysis and even death. Alternative imaging tests, including magnetic resonance imaging (MRI) and ultrasound (US), have high accuracy for detecting emergent causes of abdominal pain and do not expose patients to cancer-causing radiation nor kidney damaging contrast agents. Though guidelines advocating the use of US and MRI instead of CT exist, physicians are not routinely following them. This K08 proposal will evaluate the barriers and facilitators to the use of US and MRI in the emergency department. Dr. Repplinger is an Assistant Professor at the University of Wisconsin – Madison, with a primary appointment in the BerbeeWalsh Department of Emergency Medicine and cross-appointment in the Department of Radiology. His research focuses on evaluating radiation-free imaging alternatives to CT, particularly the use of MRI. This line of investigation has been very successful due to the care he has taken in assembling and maintaining an interdisciplinary team of collaborators with expertise in medical physics, emergency care, radiology, and health services research as well as his unique qualifications. Support from this 3-year K08 award would provide Dr. Repplinger with the dedicated time needed to successfully complete his proposed research project. Further, he would be able to pursue career development activities that will significantly accelerate his progress toward becoming an independent investigator. The proposed aims are: 1) Identify high impact barriers and facilitators to guideline-adherent use of MRI and US in the ED; 2) Design a candidate intervention bundle targeted to high impact barriers and refine it using input from key stakeholders; and 3) Test the impact of the candidate intervention bundle on image test guideline adherence for pediatric appendicitis. These aims will be accomplished using a mixed-methods approach: qualitative analysis of focus groups for aims 1 & 2 and administrative data from our electronic health record for aim 3.