Reducing Inappropriate Abdominal X-ray Requests in a Surgical Admissions Unit: A Quality Improvement Project

Area of Science:

• Radiology
• Medical Imaging
• Surgical Assessment

Background:

• Abdominal X-rays (AXRs) were commonly used for acute abdominal pain but often replaced by CT scans due to superior detail.
• This study focused on reducing inappropriate AXR requests within a surgical admission unit (SAU).

Purpose of the Study:

• To decrease the number of unwarranted abdominal X-ray (AXR) imaging requests in a surgical admission unit (SAU).

Main Methods:

• AXR requests were evaluated against national iRefer guidelines to identify inappropriate imaging.
• Three interventions were sequentially implemented: local guideline development, poster dissemination, and electronic order form modification.
• Data on AXR appropriateness and CT scan requests were collected before and after interventions.

Main Results:

• Initially, 69% of AXR requests were inappropriate, primarily for suspected bowel obstruction (60%).
• Inappropriate AXR request rates decreased sequentially to 50%, 41%, and finally 11% after the three interventions.
• The volume of CT scan requests remained stable, indicating a shift away from AXR rather than a general increase in imaging.

Conclusions:

• The implemented interventions effectively reduced the inappropriate utilization of abdominal X-rays (AXRs).
• Targeted strategies can significantly improve the appropriateness of diagnostic imaging requests in surgical settings.