Abstract
OBJECTIVE: A baseline audit of radiology referral practice before the introduction of a strategy for change involving guidelines of good practice, monitoring, and peer review. DESIGN: Prospective data collection over a continuous 12 months period at each centre sometime between January 1987 and December 1989. SETTING: Five district general hospitals and one district health authority. SUBJECTS: 159,421 inpatient discharges, deaths, and day cases and 861,370 outpatient attendances under the care of 722 consultants from 25 clinical specialties. MAIN OUTCOME MEASURES: Monitoring of x ray examination referrals per 100 inpatient discharges, deaths, and day cases and per 100 new outpatient attenders after establishment of a computerised data collection system. RESULTS: Referral rates for all x ray examinations varied between firms in the same specialty or sub-specialty by as much as eightfold for inpatients and 13-fold for outpatients, and for chest x ray examination by as much as ninefold for inpatients and 25-fold for outpatients. There was no consistent relation between high referral and teaching status of the centre or specialty or subspecialty. CONCLUSIONS: The variation that persisted at all levels of disaggregation of the data supports a recent suggestion that at least a fifth of x ray examinations carried out in Britain may be clinically unhelpful. An intervention study that examines the effect of guidelines of good practice and attendant peer review procedures on the baseline referral levels described above is needed to test this hypothesis further.