Analysis of the use of simple cranium, chest and abdomen radiology in emergency hospital services.
In 1999, some 600,000 persons were attended to by the Emergency Services of Osakidetza hospitals. Approximately two thirds were subjected to radiological explorations
This survey focuses upon the use of simple cranium, chest and abdomen radiology and will analyse its use in Emergency Services, the scientific evidence available on the application of these resources and the costs associated with their use.
During the period 1996 - 1999, the average simple radiographic exploration rate for every thousand patients attended to by the Emergency Services of Osakidetza hospitals was 672, ranging between 427 and 932 according to hospital. Approximately a third of these involved chest x-rays.
The information systems currently available do not allow us to clarify why there are these differences, although in general, all hospitals show a slight increase in rates.
No Randomised Clinical Test has been found to analyse the impact on health of using the rules, guides or protocols for clinical decisions applied in simple cranium, chest or abdomen radiology.
A panel of experts of the American College of Radiology (ACR) has classified the level of appropriateness of the use of conventional cranium, chest and abdomen radiology in different clinical situations.
The current tariff for invoicing the health services of the hospital centres within the Osakidetza network indicates that the price of a conventional radiological exploration is 1500 pesetas. The costs we have estimated amount to 1423 pesetas per exploration, of which 83% are personnel costs.
The potential saving deriving from not requesting a simple radiograph would be only 247.6 pesetas (1.5 Euros), which would correspond to variable costs.
A number of basic tools to optimise the prescription of these radiological tests would include the unification of criteria in requesting radiological tests in order to reduce the level of variability detected, the development and implementation of better information systems and research in order to improve the quality of the evidence.
Suggestions aimed at health officials and professional associations would include encouraging the development and implementation of protocols for adequate utilisation, support for the development of information systems that allow the analysis of clinical practice and the variability between professionals and information for the public on the risks and benefits of radiological explorations.
According to the scientific evidence and recommendations of expert committees, the indications for the adequate use of these tests can be summarised as follows: