Improving Clinical Information on Whole-Body CT Requests for Major Trauma: A Quality Improvement Study

Whole-body computed tomography (WBCT) is central to major trauma assessment, but appropriate justification and reporting depend on adequate clinical information at the time of request. The Royal College of Radiologists (RCR) 2024 major trauma guidance recommends six minimum data elements for trauma WBCT requests. This quality improvement project aimed to improve documentation compliance and reduce inappropriate WBCT requests at a district general hospital.

A completed audit cycle was undertaken. Consecutive adult trauma patients undergoing WBCT were identified in a baseline audit (Cycle 1; n = 100, September-December 2024) and a post-intervention re-audit (Cycle 2; n = 100, September-December 2025). Three interventions were introduced: educational feedback to Department of Radiology and Department of Emergency Medicine staff, an RCR-derived electronic request proforma embedded within CareFlow Electronic Patient Record (EPR), and real-time radiologist feedback. Primary outcomes were compliance with the six RCR minimum dataset standards and the proportion of requests meeting RCR WBCT criteria.

Baseline compliance varied across documentation domains. In Cycle 1, documentation rates were 74% for mechanism of injury, 94% for primary survey findings, 7% for haemodynamic status, 5% for preceding investigations, 13% for past medical history, and 0% for trauma team leader contact details. Following intervention, mechanism documentation improved to 100% (p < 0.001), haemodynamic status to 93% (p < 0.001), and trauma team leader contact details to 92% (p < 0.001). Primary survey documentation remained high at 97% (p = 0.306). Past medical history increased to 18% (p = 0.329), while preceding investigations remained low at 4% (p = 1.000). Requests meeting RCR WBCT criteria increased from 57% to 96% (p < 0.001), while non-compliant requests fell from 43% to 4%. This represented 39 potentially avoidable scans and approximately 780 mSv of theoretically avoided radiation exposure per 100 requests.

A theory-informed intervention combining education, a mandatory electronic proforma, and real-time radiologist feedback substantially improved trauma WBCT request documentation and reduced inappropriate requests. Embedding minimum datasets into electronic requesting systems is a low-cost, scalable strategy to support compliance with the Ionising Radiation (Medical Exposure) Regulations [IR(ME)R] 2017, as amended in 2020, and radiation stewardship.