Assessment of radiological referral practice and effect of computer-based guidelines on radiological requests in two...

To assess medical emergency radiology referral practice compared with a set of French guidelines and to measure the efficiency of computer-based guidelines on unnecessary medical imaging.

All radiological requests were computerized in the medical emergency departments of two French teaching hospitals. During control periods, radiological requests were recorded but no action was taken. During intervention periods, reminder displays on screen indicated the appropriate recommendations. Three control and three intervention periods of 1 month each were conducted. The percentage of requests that did not conform to the guidelines and variation related to periods of control and intervention were measured.

The proportion of requests that did not conform to the guidelines was 33.2% when the guidelines were inactive and decreased to 26.9% when the recommendations were active (P < 0.0001). The three imaging examinations (chest radiographs, abdominal plain radiographs and CT of the brain) accounted for more than 80% of all requests; more than 50% of abdominal plain radiographs requests did not conform with recommendations while this percentage was respectively 24.9% and 15.8% for chest radiographs and computed tomography (CT) of the brain. Seven situations accounted for 70% of non-conforming radiological referrals; in these situations, junior practitioners' knowledge was inadequate.

While the computer provided advice that was tailored to the needs of individual patients, concurrent with care, the effect of our intervention was weak. However, our study identified the few situations that were responsible for the majority of unnecessary radiological requests; we expect that this result could help clinicians and radiologists to develop more specific actions for these situations.