Reducing Inappropriate Abdominal X-ray Requests in a Surgical Admissions Unit: A Quality Improvement Project

TL;DR

This study aimed to reduce unnecessary abdominal X-ray requests in a surgical unit by implementing guidelines and changes to the request process.

Contribution

The study demonstrates that targeted interventions can significantly reduce inappropriate abdominal X-ray requests in a surgical admissions unit.

Findings

Baseline inappropriate AXR requests were 69%, dropping to 11% after three interventions.

Bowel obstruction was the most common reason for inappropriate AXR requests.

CT scan requests remained stable despite the reduction in AXR use.

Abstract

Introduction: Abdominal X-rays (AXRs) are a common investigation for acute abdominal pain. Computed tomography (CT) imaging has largely replaced AXRs as the recommended investigation of acute abdominal pain due to the greater detail and improved diagnostic information it can provide. This project aimed to reduce the number of inappropriate AXR imaging requests in a surgical admission unit (SAU).

Methods: AXR requests were compared against national radiology guidelines (iRefer) to assess if they were inappropriate. Initial baseline data were collected over three months. Three interventions were introduced to improve the rate of inappropriate requests made: (1) developing locally agreed guidelines for AXR requests, (2) placing guideline posters in the surgical assessment unit, and (3) altering the electronic AXR order form. Data were collected after each intervention period. The number of CT scan requests was collected before and after intervention 3 to assess for concurrent change in volume.

Results: At baseline, 69% of AXR requests were considered inappropriate; the majority of requests made were for bowel obstruction (BO, 60%). Overall rates of inappropriate requests improved to 50% after intervention 1, 41% after intervention 2, and 11% after intervention 3. CT scan requests remained similar pre- and post intervention 3.

Conclusion: The project has reduced the inappropriate use of AXRs following the implementation of three interventions.

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