A critical appraisal of "out-of-hours" radiography in a major teaching hospital.

The use of plain radiography performed outside normal working hours was studied at the Manchester Royal Infirmary to determine the costs of the service and where possible financial savings could be made. The annual cost of "out-of-hours" radiography was estimated to be in order of 250,000 pounds. During a selected 2-week period, 84% and 76% of all examinations performed on Accident and Emergency patients and inpatients, respectively, were found to be normal. Previous reports suggest that the number of radiographs requested in the Accident and Emergency department can be reduced without detriment to patients by the implementation of appropriate clinical guidelines. We consider that if similar guidelines were developed and applied to the use of out-of-hours radiography, substantial savings could be made. We estimate that in our hospital these savings could amount to 18% of the current expenditure on this service.