Influence of the Royal College of Radiologists' guidelines on hospital practice: a multicentre study. Royal College of Radiologists Working Party.
OBJECTIVE
To measure the effect on hospital radiology referral practice of introducing a strategy for change involving guidelines of good practice, monitoring, and peer review.


METHODS
Prospective data collection over a continuous 21-24 month period at each centre some time between January 1987 and December 1990.


METHODS
Five district general hospitals and one district health authority.


METHODS
314,663 inpatient discharges, deaths, and day cases and 1,706,781 outpatient attendances under the care of 722 consultants from 25 clinical specialties.


METHODS
Number of referrals for x ray examination per 100 inpatient discharges, deaths, and day cases and per 100 new outpatient attenders.


RESULTS
Most doctors were prepared to accept standards of clinical practice set by peers and also the monitoring and review of their practice with respect to these standards by local colleagues. 18% of firms were identified before guidelines were instituted as having persistently high referral rates. Appreciable, and often dramatic reductions in referral rates for individual x ray examinations were recorded by a substantial number of firms in every centre and in every specialty after guidelines were instituted. The major part of this reduction was achieved by some of the firms whose initial practice did not meet "high referral" criteria. Important variations in compliance with agreed standards of good practice were observed.


CONCLUSIONS
The study offers strong experimental evidence to support a recent suggestion that at least a fifth of radiological examinations carried out in NHS hospitals are clinically unhelpful. The problem of how to assure compliance with agreed standards of practice needs to be resolved. Until this happens medical audit alone is unlikely to translate good practice into common practice.
D002985:Clinical Protocols; D006767:Hospitals, District / Q000592:standards / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D010380:Peer Review; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000592:standards / Q000706:statistics & numerical data*; D011872:Radiology Department, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012955:Societies, Medical; D006113:United Kingdom