Quality improvement project aiming to reduce inappropriate use of abdominal x-rays in the ED

There is compelling evidence that AXRs have limited clinical value in the acute setting. Despite this, they are frequently used in many EDs. This quality improvement project (QIP) aimed to reduce unnecessary AXR use in a single-centre ED.

All consecutive AXRs conducted on patients aged 16 years and above in a District General Hospital ED in England between 2 August 2021 and 5 June 2022 were included. This period of time was divided into a pre-intervention and intervention period, during which iterative plan-do-study-act cycles were undertaken to implement a wide range of educational and system level interventions.

501 AXRs were performed during the QIP. The average number of AXRs per fortnight fell from 27.5 during the preintervention period to 17.6 during the intervention period and met criteria for special cause variation. No special cause variation in CT usage was observed, with an average number of 70.7 and 74 CT abdomen-pelvis scans during the preintervention and intervention periods, respectively. 119 (23.8%) AXRs showed acute and clinically significant findings, and of this group 118/119 (99.2%) underwent further imaging. In contrast, 382 (76.2%) AXRs had no acute or clinically significant findings, and of this group 344/382 (90.1%) proceeded to further imaging.

In this single-centre QIP, coordinated multidisciplinary interventions were effective in reducing unnecessary AXR usage without resulting in excess CTs. The methods and interventions described are easily reproducible at minimal expense and may be of interest to other departments undertaking quality improvement work in this area.