Administrative barriers reduce emergency physician ordering of nasal and acromiodavicular joint radiographs

The objective of this study was to determine whether administrative barriers to clinician ordering of nasal bone and acromioclavicular (AC) joint radiographs would result in a significant diminution in emergency department use of these films and in patient charges. This study involved a retrospective cohort or pre-post analysis of radiograph ordering by emergency care providers seeing adult patients with nasal area or shoulder injuries. Numbers of films ordered before and after enactment of a restrictive policy change were determined, as well as any charge reductions associated with diminished film use. For each radiograph type, there was a 1-year preintervention period, and 2 subsequent 12-month periods after the policy change. Nasal bone radiographs decreased from 166 in 1994 to 10 in 1995 and 4 in 1996 (P < .001, χ2). This resulted in potential annual charge savings of $33,176. AC joint radiographs decreased from 35 films in 1994 to 5 in 1995 and 8 in 1996 (P < .001, χ2), with potential annual charge savings of $6,578. Adoption of an interdepartmental policy that prohibits physicians from routinely ordering radiographs of limited clinical value can result in significant reduction of radiograph use. This drop in use can lead to considerable reductions in patient charges.