Table 2, Review protocol: Does the provision of 7 day diagnostic radiology in hospital improve patient outcomes? - Emergency and acute medical care in over 16s: service delivery and organisation

Review question	7 day diagnostic radiology
Guideline condition and its definition	AME. Definition: people with suspected or confirmed acute medical emergencies.
Objectives	To determine if the increase access to investigations, diagnostics and interventions in ED & AMU improves outcomes.
Review population	Adults and young people (16 years and over) admitted to hospital with a suspected or confirmed AME.
	Line of therapy not an inclusion criterion.
Interventions and comparators: generic/class; specific/drug (All interventions will be compared with each other, unless otherwise stated)	24 hour access to diagnostic radiology. Reduced access to diagnostic radiology; 7-day extended working. Reduced access to diagnostic radiology; 7-day working (9am – 5pm). Reduced access to diagnostic radiology; 6-day working. Reduced access to diagnostic radiology; 5-day working.
Outcomes	- Mortality during the study period (Dichotomous) CRITICAL - Avoidable adverse events during the study period (Dichotomous) CRITICAL - Quality of life during the study period (Continuous) CRITICAL - Patient satisfaction during the study period (Dichotomous) CRITICAL - Length of hospital stay during the study period (Continuous) CRITICAL - Time to definitive diagnosis during the study period (Continuous) IMPORTANT - Diagnostic turn around for result to healthcare professional during the study period (Continuous) IMPORTANT - Staff satisfaction during the study period (Dichotomous) IMPORTANT - Representation up to 30 days during the study period (Dichotomous) IMPORTANT
Study design	Systematic Review RCT Quasi-RCT Non-randomised comparative study Prospective cohort study Retrospective cohort study Case control study Controlled before and after study Before and after study Non randomised study
Unit of randomisation	Patient. Ward. Hospital.
Crossover study	Permitted.
Minimum duration of study	Not defined.
Other exclusions	Studies from non-OECD countries. Technological evaluation. Interventional radiology. Major trauma centres.
Population stratification	CT. MRI. Ultrasound. Nuclear medicine.
Reasons for stratification	It is known that the stratified diagnostic radiology services have different utilisation and associated costs which will impact on the effectiveness of providing a 24-hour service.
Subgroup analyses if there is heterogeneity	- Frail elderly (frail elderly; overall); different population. - Clinical condition (Stroke; Pulmonary emboli; Intracranial bleeds; Head Injury; Spinal cord compression or cauda-equina; GI bleeds); Different populations - Reporting physician (Results reported by radiographer/radiologist; Results reported by clinician); Variation in practice.
Search criteria	Databases: Medline, Embase, the Cochrane Library. Date limits for search: after 1990. Language: English only.

Review question

7 day diagnostic radiology

Guideline condition and its definition

AME. Definition: people with suspected or confirmed acute medical emergencies.

Objectives

To determine if the increase access to investigations, diagnostics and interventions in ED & AMU improves outcomes.

Review population

Adults and young people (16 years and over) admitted to hospital with a suspected or confirmed AME.

Line of therapy not an inclusion criterion.

Interventions and comparators: generic/class; specific/drug

(All interventions will be compared with each other, unless otherwise stated)

24 hour access to diagnostic radiology.

Reduced access to diagnostic radiology; 7-day extended working.

Reduced access to diagnostic radiology; 7-day working (9am – 5pm).

Reduced access to diagnostic radiology; 6-day working.

Reduced access to diagnostic radiology; 5-day working.

Outcomes

-: Mortality during the study period (Dichotomous) CRITICAL
-: Avoidable adverse events during the study period (Dichotomous) CRITICAL
-: Quality of life during the study period (Continuous) CRITICAL
-: Patient satisfaction during the study period (Dichotomous) CRITICAL
-: Length of hospital stay during the study period (Continuous) CRITICAL
-: Time to definitive diagnosis during the study period (Continuous) IMPORTANT
-: Diagnostic turn around for result to healthcare professional during the study period (Continuous) IMPORTANT
-: Staff satisfaction during the study period (Dichotomous) IMPORTANT
-: Representation up to 30 days during the study period (Dichotomous) IMPORTANT

Study design

Systematic Review

RCT

Quasi-RCT

Non-randomised comparative study

Prospective cohort study

Retrospective cohort study

Case control study

Controlled before and after study

Before and after study

Non randomised study

Unit of randomisation

Patient.

Ward.

Hospital.

Crossover study

Permitted.

Minimum duration of study

Not defined.

Other exclusions

Studies from non-OECD countries.

Technological evaluation.

Interventional radiology.

Major trauma centres.

Population stratification

CT.

MRI.

Ultrasound.

Nuclear medicine.

Reasons for stratification

It is known that the stratified diagnostic radiology services have different utilisation and associated costs which will impact on the effectiveness of providing a 24-hour service.

Subgroup analyses if there is heterogeneity

-: Frail elderly (frail elderly; overall); different population.
-: Clinical condition (Stroke; Pulmonary emboli; Intracranial bleeds; Head Injury; Spinal cord compression or cauda-equina; GI bleeds); Different populations
-: Reporting physician (Results reported by radiographer/radiologist; Results reported by clinician); Variation in practice.

Search criteria

Databases: Medline, Embase, the Cochrane Library.

Date limits for search: after 1990.

Language: English only.

From: Chapter 22, 7-day diagnostic radiology

Emergency and acute medical care in over 16s: service delivery and organisation.

NICE Guideline, No. 94.

National Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2018 Mar.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 2Review protocol: Does the provision of 7 day diagnostic radiology in hospital improve patient outcomes?