Table 5 Study results

Barter 2015 [11]

Primary: LOS^a in ED^b with RLD^c Vs SDC^d. Comparing re-attendance rates

Reduced LOS with RLD of 82 min and >20min. Reduced RLD re-attendance 53% and 26.6% for 2 included studies

Secondary: Attitudes to RLD

RLD could reduce LOS and improve services. Concerns over potential for litigation

Henderson et al. 2012 [23]

Primary: Overall LOS^a in ED^b with RLD^c Vs SDC^d

RLD mean 100.9 min. (SD 42.503, 95% CI 97.2 to 104.7). SDC (mean of data during audit, including RLD data) 122 min (SD 48.220, 95% CI 120.3 to 123.7)

Secondary: Clinically significant (CS) false negative results, and re-attendance rates within 28 day period

RLD false negative CS rate 0%. SDC false negative CS rate 1.33%. Odds ratio (OR) false negative ED: RLD 10.59 (95% CI 1.46 to 76.68). RLD re-attendance rate 2.62%, SDC 7.06% with 1.75% CS. OR re-attending with same injury ED: RLD 8.36 (95% CI 2.05 to 34.08)

Howard 2017 [9]

Primary: NCS. Patient re-attendance

No patient re-attended

Secondary: Arrival to discharge time

LOS rates were reduced; no numerical data included

Howard and Craib 2018 [25]

Primary: Time from arrival to discharge with RLD

RLD reduced length of stay. Minimum journey time 26 min

Secondary: re-attendance or recalls

No re-attendance, one recalled, no management change

Jenkins 2015 [27]

Primary: LOS x-ray to discharge with RLD Vs SDC

RLD mean 12.4 min, 72% LOS reduction. RLD with treatment pathway 18 min, 59% LOS reduction. SDC (mean of data from previous year) 44 min

Secondary: Satisfaction surveys

100% satisfaction rating from both staff and patients

Knapp et al. 2016 [13]

Primary: TNA^e for image interpretation and discharge

Radiographer sensitivity mean 66%, specificity 78%, accuracy 71%. ENP^f sensitivity 67%, specificity 54%, accuracy 62%

Secondary: DES^g modelling impact on LOS with RLD. Interviews and focus group for RLD

RLD 98.11 min 27% LOS reduction, SDC 134.07 min LOS, using 100% RLD. Interviews—more training required for RLD. Focus group – patient support for RLD

Lumsden & Cosson 2015 [24]

Primary: Survey around concept of RLD and comparison of qualitative and quantitative responses

 > 70% RLD would help: waiting time targets, LOS in hospital, inter-professional working. 85% stated salary as incentive for RLD. Litigation highest concern (68%)

Rachuba et al. 2018 [26]

Primary: modelled LOS in ED with RLD with SDC

RLD mean 98 min 66% LOS reduction. SDC 148 min when imaging requested at assessment

Secondary: Analysis of DES modelling pathways for RLD (1) when imaging requested (2) increasing RLD use (3) on different days of the week

(1) Reduction of > 50 min, imaging requested at triage rather than clinical assessment. (2) LOS decreases as RLD increases. (3) Using RLD at weekends, when 51% of all RLD eligible patients present decreases overall ED LOS by average 10%

Snaith 2006 [3]

Primary: Overall LOS with RLD Vs SDC

SDC (included patients not requiring imaging) 134 min. RLD no treatment 52 min, 61% LOS reduction. RLD with treatment average 71 min, 47% LOS reduction

Secondary: Number of patients using RLD Vs SDC and patient recall rates

114/1760 (15.9%) used RLD. Recall rate reduced by 52% when compared with data from the same time period in previous years