An audit of hip radiographs performed for general practitioners

We carried out a prospective study of the GP referrals for hip radiographs to find out the proportion of radiographs falling within the RCR guidelines and to ascertain the reasons for not following the guidelines.

One thousand two hundred and fifty six consecutive hip radiographs were performed for GPs over a 12-month period. Questionnaires were sent to GPs for 873 referrals during an audit period of 18 months Four hundred and fifty three questionnaires were returned with adequate information. The proportion of change in management between the patients falling within the guidelines and those outside the guidelines was compared using Fisher's Exact Test (SPSS Package Version 9) and the corresponding 95% confidence interval (CI) was calculated.

Only 194 (43%) of the 453 referrals were within RCR guidelines and 259 (57%) were outside guidelines. In the group where RCR guidelines were followed, 60% were normal, 34% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 44%. In the group where guidelines were not followed 76% were normal, 18% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 37%. There was no evidence of difference in the change in management between these two groups. Twenty per cent of the radiographs showed abnormalities other than hip changes. Of these, only 17% were abnormalities other than degenerative changes and considered significant.

This audit does not reveal why the majority of the requests fell outside guidelines. This may be due to lack of awareness amongst GPs about guidelines, patient pressure, medico-legal problems and the need for reassurance. However, the audit does not show any evidence that following guidelines would increase efficiency of referral.