Recent Advances: Posters for accident departments: simple method of sustaining reduction in x ray examinations

BMJ 1995;310:640-642 (11 March)

Education and debate

Recent Advances: Posters for accident departments: simple method of sustaining reduction in x ray examinations

Eugene McNally, senior registrar in diagnostic radiology,^a Gerald de Lacey, consultant radiologist,^a Philippa Lovell, registrar in accident and emergency,^a Theo Welch, consultant in charge of accident and emergency ^a

^a Departments of Radiology and Accident and Emergency, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ

Correspondence to: Dr E McNally, Department of Radiology, Nuffield Orthopaedic Centre NHS Trust, Oxford OX3 7LD.

Abstract

Objective: To assess whether a simple strategy would sustaina reduction in the number of unnecessary x ray examinations.
Design: Use of posters to display guidelines encouraging themore effective use of radiology in patients with head injuries,twisted ankles, neck injuries, and abdominal pain.
Setting: Accident department of a large metropolitan districtgeneral hospital.
Patients: 15875 patients attending the accident department overtwo years.
Main outcome measure: Proportion of patients having radiography.
Results: Referrals for skull radiography fell from 56% to 20%and those for abdominal radiography fell from 31% to 7%. Referralpatterns for adults attending with twisted ankles and cervicalspine injuries did not change. Reductions were sustained overtwo years.
Conclusion: Carefully designed posters provide a simple methodof reducing unnecessary x ray examinations.

Key messages

Key messages
Good presentation is as important as the guidelines themselves
Simple methods are more likely to be suc- cessful in the long term than complex ones
Giant coloured posters displaying guidelines have reduced unnecessary abdominal and skull x ray examinations by over half
If applied elsewhere with equal success con- siderable savings in both costs and radiation dose would occur

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Relevant Articles

Guidelines to reduce x ray examinations in accident departments: R D Hardern and D W Harmer
BMJ 1995 311: 329. [Extract] [Full Text]

Radiology guidelines could be improved: M Dudley
BMJ 1995 311: 329-330. [Extract] [Full Text]

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