Objective: To demonstrate that repetitive hand or wrist series could be minimized with minor refinements of triage.
Population: 2,119 consecutive trauma patients requiring hand or wrist series.
Method: In baseline phase I, radiographs were ordered by triage corpsmen. In phase II, RNs or physicians performed triage and ordered films. Phase III followed inservice training on strategies to minimize duplicate studies. Phase IV required the RN or physician to provide written justification for duplicate studies. The number of duplications in each phase were compared to baseline using the chi-square test of homogeneity.
Results: The phase I duplication rate was 10.8%. In phase II, the percentage of duplicate studies was 8.1% (p = 0.12). Phase III decreased duplication to 6.2% (p < 0.01). Phase IV decreased duplicate studies to 5.8% (p < 0.01).
Conclusion: In an emergency room generating over 180 hand and wrist studies monthly, minor changes in ordering practices reduced the duplication rate from 10.8% to 5.8%.