Senior physicians and radiologists at University Hospital Galway had noticed that a large number of inappropriate plain-film abdominal x-rays were being ordered outside of normal working hours on inpatients. While the appropriateness of x-ray exams has been investigated for outpatients presenting to the emergency room, the subject has been studied less for inpatient care, they noted.
A group led by Dr. Peter McAnena examined records over an eight-week period in 2016 for inpatients with plain-film radiographs performed between 5 p.m. and 9 a.m., Monday through Friday. The researchers found a total of 748 plain-film radiographs that met their criteria, of which 37.7% were requested by the emergency department and 50.5% were requested from the wards.
Of these, 154 exams met the criteria of being performed outside of working hours, with 112 (72.2%) requested by the emergency department and 30 (19.4%) performed on adult inpatients. Of these latter exams, one x-ray was abnormal, consisting of a small-bowel obstruction that was managed conservatively.
Of the remaining studies, none produced a change in patient management. Ten patients went on to have CT scans, but they experienced a median time to those studies of 25 hours (range, 6-72 hours). Three patients with negative x-ray findings were later shown to have malignancies on subsequent CT scans.
The findings prompted the group to conclude that inpatient plain-film abdominal radiographs are of limited clinical value outside of normal working hours. University Hospital Galway has yet to change its policy on ordering such x-rays, pending discussions with referring physicians and other stakeholders, but a change could be in the offing.
"A potential implication of our study would be to alter the policy of ordering abdominal x-rays in the outside-of-normal-working-hours setting," McAnena told AuntMinnie.com. "This would have two main benefits -- saving the hospital money and sparing patients from the deleterious effects of unnecessary radiation exposure."
The researchers also plan to examine the utility of plain-film abdominal radiographs acquired during normal working hours.
