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An audit evaluating the appropriateness of plain abdominal radiograph requests in the emergency department of a local district general hospital
EP33176
Poster Title: An audit evaluating the appropriateness of plain abdominal radiograph requests in the emergency department of a local district general hospital
Submitted on 18 Oct 2020
Author(s): Jonathon Kyriakides, Rahul Khamar, Raees Lunat, Aria Khani
Affiliations: Barnet General Hospital, Royal Free London NHS Foundation Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 171
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Poster Information
Abstract: Introduction
Abdominal radiographs are commonly requested in the emergency department (ED). Each
film is associated with a radiation dose equivalent to 35 chest radiographs. The Royal College of Radiologists (RCR) iRefer guidelines stipulate appropriate indications for their usage. The consequence of inappropriate requests include a waste of resources in addition to inappropriate exposure to ionising radiation.

Methods
Pre-intervention data analysis of abdominal radiograph requests in comparison to iRefer guidance over one-month was performed. A standard of 100% was set. Following this, a teaching session focusing on the iRefer guidelines was delivered to ED clinicians of all grades, in addition to the dissemination of posters within the department. Post-intervention data collection followed this.

Results
Prior to intervention, 79% of abdominal radiograph requests had an indication meeting the RCR iRefer guidelines. Abdominal radiographs were diagnostic in only 27% of cases. Following intervention, 88% of abdominal radiographs requested had an appropriate indication, with 47% being diagnostic. Furthermore, the proportion of films aiding clinical management improved by 20%. There was also a 15% decrease in the number of requests post-intervention.

Discussion
Overall, there was a significant increase in the proportion of abdominal radiographs meeting iRefer guidance. This was accompanied by a decreased volume of requests and increased diagnostic yield. Our interventions helped facilitate this through increasing awareness of both the guidelines and radiation dose associated with each study. Routine education of the iRefer guidelines will help reduce inappropriate requests. This in turn will reduce unnecessary radiation exposure, whilst also reducing financial burden.
Summary: An audit evaluating the appropriateness of plain abdominal radiograph requests in the emergency department of a local district general hospitalReferences: 1. McCooketal.(1982)Abdominalradiographyintheemergencydepartment:aprospectiveanalysis.AnnEmergMed.11(1):7-8.
2. iReferGuidelines,RCRVersion8.0.1May2017https://irefer.org.uk/guidelines
3. Morris-Stiff (2006)Abdominalradiographrequestinginthesettingofacuteabdominalpain.AnnRCollSurgEngl.88(3):270-4.
4. Chawlaetal.(2018)AbdominalradiographsintheED:currentstatusandcontroversies.JMedRadiatSci.65(4):250-1.
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