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033 Using Rapid Reviews to Influence Guidance Development in the Emergency Department Setting
  1. J Ramachandran
  1. Kaiser Permanente, Southern California Permanente Medical Group, Pasadena, USA

Abstract

Background Decision making within health care organisations often requires rapid response to emergent, controversial or high-impact issues affecting clinical and operational practices.

Context CT imaging without oral contrast for patients admitted into the Emergency Department (ED) for abdominal/pelvic pain has been proposed as a viable option to reduce the risk of contrast-induced nephropathy and allergic reactions, as well as emergency room delays and overall length of stay (LOS) in the ED. A centralised evidence assessment unit within a large health care organisation was asked to conduct a rapid evidence review to inform the development of evidence-based guidance.

Description of Best Practice A 5-step rapid review process was initiated, including: 1) Communicating with key stakeholders to determine relevant populations, interventions, comparisons, outcomes, timing and settings (PICOTS); 2) Conducting a comprehensive evidence search using a pre-established list of key databases and other sources to identify high-quality guidelines, systematic reviews and clinical trials evaluating the efficacy and diagnostic accuracy of conducting abdominal CT with and without oral contrast agents; 3) selecting and abstracting data from relevant studies; 4) evaluating and synthesising the literature; and 5) translating results for clinical/operational decision making. Findings of low- to moderate-quality evidence across outcomes, combined with operational and resource data, resulted in a decision not to implement the practice.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users Coupled with expert input from knowledgeable clinicians and stakeholders, rapid evidence reviews can be critical to shaping evidence-based guidance in Emergency Department settings.

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