title: Reducing duplicate hand and wrist series in the emergency room: experience at Madigan Army Medical Center.
abstract: OBJECTIVE
  To demonstrate that repetitive hand or wrist series could be minimized with minor refinements of triage.
  
  
  METHODS
  2,119 consecutive trauma patients requiring hand or wrist series.
  
  
  METHODS
  In baseline phase I, radiographs were ordered by triage corpsmen. In phase II, RNs or physicians performed triage and ordered films. Phase III followed inservice training on strategies to minimize duplicate studies. Phase IV required the RN or physician to provide written justification for duplicate studies. The number of duplications in each phase were compared to baseline using the chi-square test of homogeneity.
  
  
  RESULTS
  The phase I duplication rate was 10.8%. In phase II, the percentage of duplicate studies was 8.1% (p = 0.12). Phase III decreased duplication to 6.2% (p < 0.01). Phase IV decreased duplicate studies to 5.8% (p < 0.01).
  
  
  CONCLUSIONS
  In an emergency room generating over 180 hand and wrist studies monthly, minor changes in ordering practices reduced the duplication rate from 10.8% to 5.8%.
authors.affiliation: Department of Radiology, Madigan Army Medical Center, Tacoma, WA 98431-5000, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Wade
authors.forename: R A
authors.initials: RA
authors.lastname: Youngberg
authors.forename: R
authors.initials: R
authors.lastname: Liss
mesh_terms: D004632:Emergency Medical Services / Q000191:economics*; D006230:Hand Injuries / Q000000981:diagnostic imaging*; D006300:Health Services Misuse / Q000191:economics*; D006772:Hospitals, Military; D006801:Humans; D008887:Military Medicine; D010818:Practice Patterns, Physicians' / Q000191:economics; D011859:Radiography; D014481:United States; D014954:Wrist Injuries / Q000000981:diagnostic imaging*