Recent Advances: Posters for accident departments: simple method of sustaining reduction in x ray examinations

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Abstract
Objective: To assess whether a simple strategy would sustain a reduction in the number of unnecessary x ray examinations. Design: Use of posters to display guidelines encouraging the more effective use of radiology in patients with head injuries, twisted ankles, neck injuries, and abdominal pain. Setting: Accident department of a large metropolitan district general hospital. Patients: 15875 patients attending the accident department over two years. Main outcome measure: Proportion of patients having radiography. Results: Referrals for skull radiography fell from 56% to 20% and those for abdominal radiography fell from 31% to 7%. Referral patterns for adults attending with twisted ankles and cervical spine injuries did not change. Reductions were sustained over two years. Conclusion: Carefully designed posters provide a simple method of reducing unnecessary x ray examinations. Key messages Good presentation is as important as the guidelines themselves Simple methods are more likely to be suc- cessful in the long term than complex ones Giant coloured posters displaying guidelines have reduced unnecessary abdominal and skull x ray examinations by over half If applied elsewhere with equal success con- siderable savings in both costs and radiation dose would occur