ABSTRACT 774

Abstract

Background and aims: Prior to 2010, x-rays in emergency department at our hospital were authorized by any doctor at all levels of education. In mid 2010, we introduced a protocol that all x-rays for children in emergency department should be authorized by the consultant during working hours and at night by the seniormost doctor who is usually a registrar. Aims: Primary objective of the protocol was to reduce unnecessary x-rays in children. Secondary aims were to encourage academic discussion early on in the management of sick children and not have any harmful effect by reducing the number of x-rays. Methods: We analyzed the data pre and post introduction of protocol for 18 months each way. We have a computerized system of x-ray from ordering to reporting by the radiologist. We also analyzed the data of re-admission for children who were discharged to look for any harmful effects. Results: We reduced the x-rays in children by over 400% with the introduction of the protocol. No child came to any harm. Less than 1% children required x-ray after admission to the hospital. Conclusions: Consultant approved radiological investigations have significant reduction in number of investigations. Academic discussion and benefit of senior opinion are added advantages. economic analysis would prove ahuge savings too with this method. Long term unseen gains like radiation related cancer remain to be seen in future. We recommend that all pediatric radiological investigations should be approved by a consultant or the most senior doctor in the department.