Objective

To assess whether a simple strategy would sustain a reduction in the number of unnecessary x ray examinations.

Design-Use of posters to display guidelines encouraging the more effective use of radiology in patients with head injuries, twisted ankles, neck injuries, and abdominal pain.

Setting-Accident department of a large metropolitan district general hospital.

Patients-15 875 patients attending the accident department over two years, Main outcome measure-Proportion of patients having radiography.

Results

Referrals for skull radiography fell from 56% to 20% and those for abdominal radiography fell from 31% to 7%. Referral patterns for adults attending with twisted ankles and cervical spine injuries did not change.

Reductions were sustained over two years.

Conclusion-Carefully designed posters provide a simple method of reducing unnecessary x ray examinations.