549 Reducing Inappropriate Abdominal X-Rays Requests for Acute Abdominal Pain in the Emergency Department: A Quality Improvement Project

Aim Acute abdominal pain is a common presentation to emergency departments (ED) in the UK. Abdominal x-rays (AXR) were historically the first line investigation, however, have been largely replaced by more accurate imaging modalities such as computed tomography (CT) scanning. The Royal College of Radiologist iRefer guidelines list only a few indications for using AXR in acute abdominal pain. This quality improvement project aimed to reduce the number of inappropriate abdominal x-rays requested for acute abdominal pain in ED. Method Baseline data was retrospectively collected over 4 months. AXR indications were assessed against a locally agreed adapted iRefer guideline. Two interventions were introduced including altering the electronic AXR request form (intervention 1) and teaching to ED juniors (intervention 2). Further data collection took place following each intervention implemented. CT scan volume was collected to measure for impact from the request form change. Results Baseline data showed 82% of requests were inappropriate, bowel obstruction (BO) was the most frequently requested indication (75%). Inappropriate request rate improved to 74% following intervention 1 and 52% following intervention 2. BO request reduced to 60% and 42% following respective interventions. There was no change in the volume of CT scans requested. Conclusions Our project has significantly improved the use of AXR from 82% to 52% and reduced the request rate for BO. Further iterations of the AXR request are planned to continue this improvement and ensure the changes are maintained.