Do hospitals adhere to the Blue Cross/Blue Shield Association's guidelines for admission chest x-rays and ECGs?

In 1987, the Blue Cross and Blue Shield Association (BCBSA) promulgated guidelines for some common diagnostic studies, including preoperative and general hospital admission chest x-rays and electrocardiograms. Pennsylvania Blue Shield, through reviews of patients' charts at 10 hospitals in Pennsylvania, examined whether chest x-ray and ECG studies were being ordered routinely upon hospital admission, without regard to medical necessity, and whether those that had been ordered fell within the BCBSA guidelines. Most charts reviewed (82%) had no studies that fell outside the guidelines' indications. In 24% of the cases, neither study had been performed. Some 23% of chest x-rays and 14% of ECGs performed were found to be unindicated. However, performances of the hospitals were quite variable, ranging from 8-31% of admissions with at least one unindicated study. At no hospital was there evidence that studies were ordered routinely on all admissions.