Reducing unnecesary chest x-ray requesting in patients presenting with chest pain

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Background & Problems

Chest X-Ray (CXR) requesting is commonplace for patients in the ED and Acute Medical Units. Where the CXR is not answering a specific question (a 'focused' investigation), it has a low positive yield, high cost (approximately £75) and exposes many to unnecessary radiation. In addition, it contributes to a heavy workload in radiology as well as consuming valuable resources.

Aim

The primary aims of this project were to improve amongst medical staff of the importance and benefits of using investigations in a focused manner which will improve the yield (number of true positive results) whilst reducing the numbers of 'false positives' (spurious positive results which may cause difficulty in clinical decision making) as well as negative results, without increasing the risk of missed pathology.

Results

The results so far indicate a reduction in CXR requesting of between 35% and 37%in patients presenting with cardiac sounding chest pain following relatively simple interventions to modify requesting practice in ED and AMU/ACUC

Significant improvement in compliance with NICE guidelines.

The modification has not resulted in anymissed pathology.

Repeat audit appears to show consistency which is encouraging.

Implications

Secondary audits were smaller and potentially subject to a Type 1 error. Repeat audits should reduce the risk.