title: Knowledge Translation and Barriers to Imaging Optimization in the Emergency Department: A Research Agenda.
abstract: Researchers have attempted to optimize imaging utilization by describing which clinical variables are more predictive of acute disease and, conversely, what combination of variables can obviate the need for imaging. These results are then used to develop evidence-based clinical pathways, clinical decision instruments, and clinical practice guidelines. Despite the validation of these results in subsequent studies, with some demonstrating improved outcomes, their actual use is often limited. This article outlines a research agenda to promote the dissemination and implementation (also known as knowledge translation) of evidence-based interventions for emergency department (ED) imaging, i.e., clinical pathways, clinical decision instruments, and clinical practice guidelines. We convened a multidisciplinary group of stakeholders and held online and telephone discussions over a 6-month period culminating in an in-person meeting at the 2015 Academic Emergency Medicine consensus conference. We identified the following four overarching research questions: 1) what determinants (barriers and facilitators) influence emergency physicians' use of evidence-based interventions when ordering imaging in the ED; 2) what implementation strategies at the institutional level can improve the use of evidence-based interventions for ED imaging; 3) what interventions at the health care policy level can facilitate the adoption of evidence-based interventions for ED imaging; and 4) how can health information technology, including electronic health records, clinical decision support, and health information exchanges, be used to increase awareness, use, and adherence to evidence-based interventions for ED imaging? Advancing research that addresses these questions will provide valuable information as to how we can use evidence-based interventions to optimize imaging utilization and ultimately improve patient care.
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Probst
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Columbia University College of Physicians & Surgeons, New York, NY.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Slovis
authors.affiliation: Department of Emergency Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA.
authors.forename: Kabir
authors.initials: K
authors.lastname: Yadav
authors.affiliation: Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Lam
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Shapiro
authors.affiliation: RAND Corporation, Santa Monica, CA.|Central Michigan University College of Medicine, Mount Pleasant, MI.
authors.forename: Coreen
authors.initials: C
authors.lastname: Farris
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, MI.
authors.forename: Charlene I
authors.initials: CI
authors.lastname: Babcock
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Griffey
authors.affiliation: Department of Emergency Medicine, Waterbury Hospital, Yale University, New Haven, CT.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Robey
authors.affiliation: Central Michigan University College of Medicine, Mount Pleasant, MI.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Fortin
authors.affiliation: Department of Radiology, Emory Healthcare, Atlanta, GA.
authors.forename: Jamlik O
authors.initials: JO
authors.lastname: Johnson
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Suzanne T
authors.initials: ST
authors.lastname: Chong
authors.affiliation: Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA.
authors.forename: Moira
authors.initials: M
authors.lastname: Davenport
authors.affiliation: Alberta Health Services, Emergency Strategic Clinical Network, Calgary, Alberta, Canada.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Grigat
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eddy L
authors.initials: EL
authors.lastname: Lang
mesh_terms: D000066491:Clinical Decision-Making; D003245:Consensus Statements as Topic; D003952:Diagnostic Imaging / Q000592:standards / Q000706:statistics & numerical data*; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D055416:Evidence-Based Emergency Medicine; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D017410:Practice Guidelines as Topic; D057170:Translational Research, Biomedical / Q000458:organization & administration*