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Appropriate request of Abdominal Radiographs in the Emergency Department
EP29077
Poster Title: Appropriate request of Abdominal Radiographs in the Emergency Department
Submitted on 01 Nov 2018
Author(s): Fellows M; Jenkins J; Burkey H; Tzias D
Affiliations: Ashford and St Peter's NHS Foundation Trust
This poster was presented at BIR Annual Congress 2018
Poster Views: 324
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Poster Information
Abstract: Submission Title:
Appropriate request of Abdominal Radiographs in the Emergency Department

Authors:
Fellows M, Burkey H. Ashford and St. Peter’s NHS Trust

Background and Purpose:
There is a high volume of abdominal radiograph (AXR) requests from the Emergency Department (ED) at St Peter’s Hospital (SPH). AXR radiation is up to 50 times greater than a chest radiograph, hence there is concern that patients are being over exposed. This study aims to identify the proportion of requests that adhere to the Royal College of Radiologists iRefer guidelines and therefore ensure that patients are being investigated appropriately.

Standard:
Abdominal film requests in ED to meet the iRefer criteria. Target: 100%.

Methodology:
A retrospective study of all abdominal radiographs requested by ED over a 10 day period in January 2018 and reaudited over a 4 day period in March 2018.

Cycle 1 Results:
There were 108 requests (mean 10.8 films/day). 85% of films were unremarkable, 6% showed faecal loading only and 9% had abnormal findings. 73% of requests met the iRefer criteria, however, only 80% of these had appropriate clinical detail.

1st Action plan:
To present findings at departmental meetings, educate staff in the ED using, and lastly to re-audit to assess impact.

Cycle 2 Results
There were 54 requests (mean 13.5 films/day). 74% of films were unremarkable, 13% showed faecal loading only and 13% had abnormal findings. There is a small improvement from Cycle 1. 81% of requests met the iRefer criteria, of which 80% of these had adequate appropriate clinical detail.

2nd Action plan:
To discuss re-audit findings with both departments, present at the next ED junior doctor induction, and consider protocolling scans.
Summary: A dual cycle audit looking into the appropriateness of requesting of abdominal radiographs in the Emergency Department at St. Peter's Hospital.References: 1. iRefer Guidelines, RCR Version 7.0.2 January 2012 adult abdomen https://www.rcr.ac.uk/clinical-radiology/being-consultant/rcr-referral-guidelines/accessing-guidelines
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