After-hours x-ray may not be necessary

Wednesday, November 29 | 12:15 p.m.-12:45 p.m. | ER225-SD-WEA1 | Lakeside, ER Community, Station 1
In this study, researchers from Ireland found that plain-film abdominal radiographs performed outside of standard working hours were rarely useful and exposed patients to unnecessary radiation while using scarce hospital resources.

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.

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