Purpose: Diagnostic Imaging Pathways (DIP) is an ‘on-line’ evidencebased decision support tool (http://www.imagingpathways.health.wa.gov.au) that was developed at Royal Perth Hospital (RPH) to facilitate appropriate diagnostic imaging requesting behaviour amongst clinicians.

This study aims to evaluate compliance of diagnostic imaging requests to recommendations outlined in DIP and reasons for non-compliance.

Methods and materials: Retrospective audits, followed by intervention and re-audits were carried out in the Emergency Department (ED).

Pathways targeted were: ‘Suspected Pulmonary Embolism’, ‘Ankle Injury’ ‘Suspected Renal Colic’ and ‘Non Traumatic Acute Abdominal Pain’.

Interventions included: regular reminders to staff to refer to DIP, education on DIP recommendations, introduction of request forms detailing “proof” of adherence to pathways, and refusal of inappropriate examinations.

Results: In the initial audits (N 658), 285 (43%) received imaging of doubtful appropriateness whilst 158 (24%) received examinations without indications. Follow-up audits demonstrate only partial improvements in compliance. Requesters failed to follow recommendations for many reasons including: insufficient time to learn about recommendations; disbelief in their validity; failure to understand the importance of adhering to recommendations. Requesters may provide inaccurate pre-requisite information or ‘pressurise’ providers to accept a request without pre-requisites. Providers fail in their ‘gatekeeper’ function because of insufficient time to deliver education, difficulty obtaining pre-requisite information, and reluctance to resist a demand.

Conclusion: Targeted interventions were only partially successful in eliminating non-compliance with evidence-based pathways (DIP) amongst clinicians in this study. Future investigations should examine the extent to which information-communication technology linked to electronic ordering of imaging can suppress inappropriate practice.




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