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Education And Debate

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

BMJ 1995; 310 doi: (Published 11 March 1995) Cite this as: BMJ 1995;310:640
  1. Eugene McNally, senior registrar in diagnostic radiologya,
  2. Gerald de Lacey, consultant radiologista,
  3. Philippa Lovell, registrar in accident and emergencya,
  4. Theo Welch, consultant in charge of accident and emergency
  1. a Departments of Radiology and Accident and Emergency, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ
  1. Correspondence to: Dr E McNally, Department of Radiology, Nuffield Orthopaedic Centre NHS Trust, Oxford OX3 7LD.
  • Accepted 10 February 1995


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


    • Accepted 10 February 1995
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