Table 4 Study characteristics

Barter 2015 [11]

RLD impact on quality of ED services and professional practice

Examine barriers and disadvantages of RLD

Review of literature for RLD

Not clearly stated (NCS)

Patients receiving RLD compared with standard discharge, radiographers and radiologists. Participant numbers NCS^a

All studies of RLD from 2000 until publication, including all interpretations of RLD

Henderson et al. 2012 [23]

Can RLD reduce x-ray to discharge LOS^b without impact on patient outcome

NCS^c but arrival to discharge LOS was compared in the study. Recall and re-attendance rates

Prospective audit of RLD

1 North east (NE) England General Hospital ED department

 > 5 years old. Below elbow/ knee injury, able to weight bear and be discharged after x ray with no follow up. 497 in intervention, 2632 comparators

3 month pilot audit then 2 year audit. RLD defined as reporting radiographer discharging patients, with advice, whose ENP^d or Doctor wrote a discharge plan for negative x ray findings at initial consultation. Standard discharge comparator

Howard 2017 [9]

Feasibility of RLD in a community hospital

Explore the impact of RLD in terms of the patient pathway

Feasibility comparing RLD with standard discharge comparator

1 community hospital Minor injury unit in NE Scotland

 > 2 years old for extremity musculoskeletal injury below knee & shoulder. Participant number not clearly stated

6 month, RLD process of discharge of patients with minor musculoskeletal injuries, with written radiographer comment of no acute bony/joint abnormality. Radiographer offers advice/ minor treatment. Standard discharge comparator

Howard and Craib 2018 [25]

Assess if RLD reduced patient LOS

Does RLD reduce patient recall or re-attendance rates

Not clearly stated

1 community hospital MIU in NE Scotland

30 patients with no bony injury on x-ray

Duration not clearly stated. RLD process defined as discharge of patients with no bony or joint injury. Standard discharge comparator.

Jenkins 2015 [27]

Can RLD reduce x-ray to discharge LOS, improve patient flow with RLD

Assess if RLD improves overall patient experience

Pilot study of RLD

1 hospital emergency unit in Wales

Intervention 5 children with suspected fractures. Standard discharge comparator of 6 children attending same date and time in previous year

1 afternoon of reporting radiographer using RLD for paediatrics, following competency based 30 h prep including treatment advice and recognising when follow up treatment is required. Standard discharge comparator

Knapp et al. 2016 [13]

Investigate local requirement for reporting radiographers

Review the potential application of RLD

TNA^e, focus groups, interviews and discrete event simulation for RLD

South west England, 2 site Training needs analysis and 1 site modelling

3 ED interviews. 8 ENPs, 2 ED consultants, 20 radiographers training needs analysis. Focus group with patients/carers. Modelling of ED data matching RLD criteria- number NCS

3 interviews and 1 focus group meeting with researchers. TNA for image interpretation and discharge, numbers NCS. Modelling based on historic data from 2 years. RLD was Not clearly stated

Lumsden & Cosson 2015 [24]

Radiographer attitudes to RLD

Radiographer opinions of salary with RLD

Cross-sectional design survey

7 hospitals across NE England

300–500 questionnaires sent to radiographers. 101 participant uptake

Survey of radiographer views of RLD with no single RLD definition. Timeframe not clearly stated for data gathering

Rachuba et al. 2018 [26]

Use evidence based model to review impact on LOS for RLD suitable patients

Can discrete event simulation modelling be used as a decision support tool for RLD

Discrete event simulation of 2 pathways using RLD

1 South west England district general hospital

Patients who either had minor appendicular injuries or lower limb injuries

1303 in intervention group and 1507 in comparator group

23 months historic data modelling pathways for RLD. RLD defined as; patient with no other condition and normal x ray, discharged with appropriate instructions, and doctor pre-authorisation. Modelling data compared to simulated standard discharge

Snaith 2007 [3]

Assess if RLD could reduce LOS in A&E^f pathway

Could hot reporting reduce recall rate

Pilot study of RLD

1 Mid- Yorkshire hospital A&E department

114 patients between 5 and 65 years old, with x ray imaging of distal extremities, excluding knees and shoulders

4 month pilot of RLD, defined as radiographers hot reporting images and discharging patients with advice, using discharge plan written at initial assessment. Standard discharge comparator