title: Implementing a guideline for the request of chest and abdominal x-rays in nontrauma pathologic conditions in an ED.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the impact of implementing a guideline for the request of chest and abdominal x-ray to reduce unnecessary examinations in nontraumatic pathologic conditions.
  
  
  METHODS
  We selected most common chief complaints in nontrauma pathologic conditions at emergency department (ED) and reviewed the available literature to determine the effectiveness of chest and abdominal x-rays for each one. We developed a guideline for the request of x-rays according to the chief complaints, including modulating factors derived from initial clinical evaluation. Guideline implementation was achieved through a multifaceted educational intervention. To evaluate its impact, both in the absolute number and in the adequateness of x-ray requests, we compared data obtained from patients coming to the ED at 2 different time points, October 2004 (preimplementation) and October 2005 (postimplementation).
  
  
  RESULTS
  In the preimplementation period, 52.7% of the patients underwent chest x-rays and 28.0% abdominal x-rays, whereas in the postimplementation period, the proportions decreased to 41.8% and 13.5%, respectively (P<.001 in both cases). The adequateness of x-ray requests improved, as shown by a reduction in the number of inappropriate x-ray examinations (absolute error reduction of 9.2%; 95% confidence interval, 7.7-10.8, and relative error reduction of 59.8%; 95% confidence interval, 49.7-69.8).
  
  
  CONCLUSIONS
  In our ED, implementing a specifically designed guideline for the request of chest and abdominal x-ray examinations in nontraumatic pathologic conditions reduced the absolute number of requests and the rate of inappropriate requests.
authors.affiliation: Emergency Department, Hospital Ramón y Cajal, Madrid 28034, Spain. Electronic address: mariaeugenia.hryc@gmail.com.
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Cobo
authors.affiliation: Radiology Department, Hospital Ramón y Cajal, Madrid 28034, Spain.
authors.forename: Agustina
authors.initials: A
authors.lastname: Vicente
authors.affiliation: Emergency Department, Hospital Ramón y Cajal, Madrid 28034, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Corres
authors.affiliation: Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela
authors.affiliation: Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
mesh_terms: D004636:Emergency Service, Hospital; D006801:Humans; D017410:Practice Guidelines as Topic; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic