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

doi:10.1136/bmj.310.6980.640

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Eugene McNally, senior registrar in diagnostic radiologya,
Gerald de Lacey, consultant radiologista,
Philippa Lovell, registrar in accident and emergencya,
Theo Welch, consultant in charge of accident and emergency

^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.

Accepted 10 February 1995

Abstract

Objective: To assess whether a simple strategy would sustain a reduction in the number of unnecessary x ray examinations.

Design: Use of posters to display guidelines encouraging the more effective use of radiology in patients with head injuries, twisted ankles, neck injuries, and abdominal pain.

Setting: Accident department of a large metropolitan district general hospital.

Patients: 15875 patients attending the accident department over two 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%. Referral patterns for adults attending with twisted ankles and cervical spine injuries did not change. Reductions were sustained over two years.

Conclusion: Carefully designed posters provide a simple method of 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