Multicentre trial of four strategies to reduce use of a radiological test

The Royal College of Radiologists' guidelines on the use of pre-operative chest X-rays were implemented for 1 year in four hospitals in England and Wales. The strategies adopted were: (1) the appointment of a utilisation review committee; (2) getting feedback on use to consultants; (3) the introduction of a new chest X-ray request form; or (4) the concurrent reviewing of chest X-ray requests by the radiology department. The lowest level of use (8.5 pre-operative chest X-rays per 100 elective operations) was achieved with the utilisation review committee after it displayed the guidelines in surgical wards. Information feedback produced a consistent reduction from 29.4 to 13.3 X-rays per 100 operations. Both the new request form and concurrent review had a moderate and intermittent effect. No change in practice occurred in a control hospital.