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

项目总结/摘要 腹痛是急诊科患者最常见的主诉。的 对这些患者的评估经常涉及使用医学成像。计算机断层扫描（CT）是由 迄今为止最广泛使用的成像模式，但暴露患者的辐射水平， 他们有患癌症的风险。用于CT扫描的静脉造影剂也已知会引起 肾损伤，导致透析甚至死亡。替代成像检查，包括磁共振 成像（MRI）和超声（US）对于检测腹痛的紧急原因具有高准确性， 不要使患者暴露于致癌辐射或损害肾脏的造影剂。虽然准则 尽管存在提倡使用US和MRI而不是CT的情况，但医生并没有常规地遵循它们。K08 提案将评估在急诊科使用US和MRI的障碍和促进因素。 博士雷普林格是威斯康星州-麦迪逊大学的助理教授， 在BerbeeWalsh急诊医学部和交叉任命的部门， 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 核磁共振由于他在组装时的小心，这条调查路线非常成功， 维持一个跨学科的合作者团队，具有医学物理学，急救护理， 放射学和卫生服务研究以及他独特的资格。3年K 08的支持 该奖项将为Repplinger博士提供成功完成其拟议工作所需的专门时间 研究项目。此外，他将能够从事职业发展活动， 加速他成为独立调查员的进程 提出的目标是：1）确定高影响的障碍和促进者，以遵循指南使用MRI， 美国在艾德; 2）设计针对高影响障碍的候选干预措施包，并使用 关键利益相关者的意见;以及3）测试候选干预措施包对图像测试的影响 儿科阑尾炎的治疗指南这些目标将使用混合方法来实现 方法：对目标1和目标2的焦点小组进行定性分析，并从我们的电子卫生系统获得行政数据 目标3创纪录。

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.