1. Dr W Courtney1*, Dr P Kelly2,Dr L Griffin3,Dr J Crotty4
A completed auditcycle on the rejection of NCHD radiologicalimaging requestsin a tertiary
referral hospitalfromAugust2014- February 2015.
Radiologydepartment,LimerickUniversityHospital,Dooradoyle,Co.Limerick.Mid- WestIntern
trainingNetwork.
Introduction: A proportionof radiological investigationrequestforms,orderedbyNon- Consultant-
Hospital-Doctors(NCHDs),are rejectedbyradiological departmentsinhospitalsthroughoutIreland
eventhoughthere are clearguidelinesonthe indicationsforperformingsuchradiological
investigationsonpatients.Rejectionratesof three commonlyorderedscanswere examinedinan
attemptto identifyanycommonerrorsorbarriers.
Aims: 1. To quantifythe rejectionof radiological requestformsforultrasoundof abdomen(US-
abdomen),USof pelvis(US-pelvis)andcomputedtomographyof the abdomenandpelvis(CT-
abdomen/pelvis). 2.To establishwhichlevelof NCHDismostcommonlydeniedradiological
requests. 3.To performan interventionandattempttodecrease the proportionof rejected
radiological investigationrequests.
Materialsand Methods:Radiological requestformsforUS-abdomen,US-pelvis,andCT-
abdomen/pelviswere searchedforonanelectronicdatabase overaninitial tenweekperiod.The
data was analysedandfeedbackwasgathered,viaquestionnaire,fromasample of service users
(interns),andinformalinterviewswere heldwithaconsultantradiologist.Aneducational
interventioncomprisingof aleaflet,withcommonlymade mistakes,andadvice,wascreatedand
distributedtointerns.Thiswasfurtherreinforcedbysemi- formal tutorialsessionsoveratwoweek
period.We thencommencedare- auditof scan requests.
Results:In total,1315 radiological requestformswere reviewedinthe firstcycle.CT-
abdomen/pelviswasthe mostcommonlyrejectedradiological investigation(12.39% rejectionrate)
and internswere the mostcommonlydeniedNCHD(42.40% of all rejections).Datafromthe re-
auditshowsthat internrejectionrates,forall three scans, were reduced.The greatestreductionwas
seeninthe rejectionof CT-abdomen/pelviswhere internrejectionsfellfrom42.40% to 25.90%.
Interestingly,the overall NCHDrejectionrate forCT-abdomen/pelvisremainedthe same.
Conclusions: Our studyshowsa focusededucationalinterventioncandecrease the proportionof
radiological requestformsfrominternsbeingrejected.Thiscanreduce the numberof rejected
requestsandallowinternstoworkmore efficiently,Improve communicationbetweenInternsand
the radiologydepartment,andpossiblyshorten inpatientstays.
We wouldrecommendbuildingonoureducational intervention- atinterneducationatinduction
and throughoutthe year.The conceptof extendingthisinterventiontootherNCHDgroups is
possible.Oureducational leafletwill be incorporatedintothe published internhandbookfor
followingyears.
Reference:
(1): The AmericanCollegeof Radiology.Available from:http://www.acr.org