IMPACT Requests: Evaluating the Effectiveness of IMPACT Education for Emergency Department Referrers to Improve the Quality of CT Requests
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Updated: Mar 7, 2026

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Published on: January 15, 2017
Chelsea Castillo1,2, Tom Steffens2, Georgia Livesay1
1Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
Introduction:
The quality of radiology reports is closely linked to clinical information provided by referrers. Inadequate information can lead to broader differential diagnoses, delayed decisions and lower-value healthcare. To address this, the IMPACT (Information Medically Pertinent for Acute Computed Tomography) criteria were developed to guide referrers on essential clinical details for computed tomography (CT) requests in emergency settings. This study aimed to evaluate whether education based on these criteria-IMPACT Education-improved the quality of CT requests.
Methods:
A cross-sectional study was conducted in a large Australian, metropolitan, trauma hospital. Junior doctors in the Emergency Department (ED) were provided with IMPACT Education, a multi-modal teaching program based on rationalised, mnemonic-driven clinical criteria for chest, abdomen and multi-trauma CT requests. A total of 1200 CT requests, 200 made before education (the control group) and 200 made by referrers after completing education (post-education group) for each scan region were assessed for compliance with the IMPACT Criteria. Statistical analyses included Chi-square and Mann-Whitney U tests to assess changes in individual criteria and overall request scores between the two groups.
Results:
Overall mean request scores were significantly higher for all scan types in the requests made by those who completed the education, compared to the control group. For CT chest and abdomen, the majority of individual criteria showed significant improvements in the post-education sample. CT multi-trauma requests showed more modest gains, possibly due to clinical urgency and complexity.
Conclusion:
The IMPACT Education program improved the quality of clinical information in CT requests from ED referrers for CT chest, abdomen and multi-trauma presentations. The success of the education is attributed to the use of evidence-based teaching strategies. The next phase of this project will investigate the impact of this improvement in request quality on the quality of resultant radiology reports.
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