World Hosp. 1992;28(1):7-13.
A baseline audit of radiology referral practice before the introduction of a strategy for change involving guidelines of good practice, monitoring, and peer review.
Prospective data collection over a continuous 12 months period at each centre sometime between January 1987 and December 1989.
Five district general hospitals and one district health authority.
159,421 inpatient discharges, deaths, and day cases and 861,370 outpatient attendances under the care of 722 consultants from 25 clinical specialties.
Monitoring of x ray examination referrals per 100 inpatient discharges, deaths, and day cases and per 100 new outpatient attenders after establishment of a computerised data collection system.
Referral rates for all x ray examinations varied between firms in the same specialty or sub-specialty by as much as eightfold for inpatients and 13-fold for outpatients, and for chest x ray examination by as much as ninefold for inpatients and 25-fold for outpatients. There was no consistent relation between high referral and teaching status of the centre or specialty or subspecialty.
The variation that persisted at all levels of disaggregation of the data supports a recent suggestion that at least a fifth of x ray examinations carried out in Britain may be clinically unhelpful. An intervention study that examines the effect of guidelines of good practice and attendant peer review procedures on the baseline referral levels described above is needed to test this hypothesis further.
在引入一项变革策略（包括良好实践指南、监测和同行评审）之前，对放射学转诊实践进行基线审核。
在1987年1月至1989年12月期间的某个时间，在每个中心连续12个月进行前瞻性数据收集。
五家地区综合医院和一个地区卫生局。
159421例住院患者出院、死亡及日间病例，以及来自25个临床专科的722名顾问医生所诊治的861370例门诊患者。
在建立计算机化数据收集系统后，监测每100例住院患者出院、死亡及日间病例以及每100例新门诊患者的X光检查转诊情况。
同一专科或亚专科内不同医院之间，所有X光检查的住院患者转诊率差异高达8倍，门诊患者转诊率差异高达13倍；胸部X光检查的住院患者转诊率差异高达9倍，门诊患者转诊率差异高达25倍。高转诊率与中心或专科及亚专科的教学地位之间没有一致的关系。
在数据细分的各个层面持续存在的差异支持了最近的一项建议，即在英国进行的X光检查中，至少五分之一可能在临床上并无帮助。需要进行一项干预研究，以检验良好实践指南及相关同行评审程序对上述基线转诊水平的影响，从而进一步验证这一假设。
