Prevalence of unjustified emergency department x-ray examination referrals performed in a regional Queensland hospital: a pilot study

Rawle, Marnie, and Pighills, Alison (2018) Prevalence of unjustified emergency department x-ray examination referrals performed in a regional Queensland hospital: a pilot study. Journal of Medical Radiation Sciences, 65 (3). pp. 184-191.

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Introduction: The underpinning principles of radiation protection are justification, optimisation and limitation. Each medical imaging referral that uses ionising radiation must balance the justification of exposure to radiation against the benefits of the examination. Scrutiny of justification is the role of radiographers, for general radiography, and is usually performed using the clinical details provided on the referral. International studies report up to 77% of medical imaging examinations are unjustified or inappropriate. In regional Queensland, justification seems to involve a subjective assessment and enforcement is ad hoc. This study aimed to determine the number of unjustified emergency department x-ray examinations performed in a regional Queensland hospital.

Methods: An audit of the clinical details provided on x-ray referrals and in the medical records was performed on x-ray examinations undertaken within an 11-day period. Justification was determined by compliance with the Government of Western Australia's diagnostic imaging pathways.

Results: Of the 186 referrals assessed, 75.3% were categorised as not having complied with the imaging pathway and were considered unjustified. When the clinical details in the patient's medical record were reviewed, in conjunction with the referral, the unjustified rate reduced to 49.2% of examinations.

Conclusion: Results demonstrate a lack of information transfer by referring clinicians and a lack of compliance with justification requirements for imaging by medical imaging staff. Improved communication regarding the need for imaging, and the refusal of referrals that are not justified, will ensure that patients are only exposed to radiation when clear benefit has been demonstrated.

Item ID: 56710
Item Type: Article (Research - C1)
ISSN: 2051-3909
Keywords: x-ray, emergency department, justification, diagnostic imaging, practice guidelines, radiography, utilisation review
Copyright Information: Copyright 2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Date Deposited: 03 Jan 2019 01:36
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320222 Radiology and organ imaging @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services) @ 20%
92 HEALTH > 9202 Health and Support Services > 920203 Diagnostic Methods @ 80%
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