A clinical audit of radiology request forms in private clinics in Asaba, Nigeria, has found that not a single form was completely filled when the audit began, but that targeted feedback and simple interventions produced a marked improvement within a year. The audit, conducted at Ideal Diagnostics, a radiology referral centre in Asaba, Delta State, was published in the Egyptian Journal of Radiology and Nuclear Medicine. It offers a rare documented look at documentation quality in private healthcare settings, which the authors note are frequently overlooked in audit practices compared with public hospitals.
A radiology request form is the document a referring doctor writes to formally request a specific imaging study from a radiology department. It carries the patient’s demographics, the clinical history and examination findings prompting the request, a provisional diagnosis, the requested examination, and the referring doctor’s name and signature. According to the audit’s authors, a properly filled form helps the radiologist and radiographer reach an accurate diagnosis, reduces patient waiting times and expenses, and ensures that radiation exposure is justified. Inadequately filled forms, by contrast, may mislead the radiographer into performing the wrong investigation or lead the radiologist to an incorrect diagnosis. Although no universal standard governs how such forms should be designed, the Royal College of Radiologists states in its guidelines that all forms should be completed adequately and legibly to avoid misinterpretation.
The audit was carried out in two cycles, from May to September 2023 and from May to September 2024, at Ideal Diagnostics, located at 16 Anwai Road, Asaba, which receives requests from both private and public hospitals in the city. Asaba, the capital of Delta State, is home to 32 private clinics. In each cycle the researchers analysed 320 radiology request forms, drawn from 16 selected private clinics with 20 forms chosen randomly from each. The diagnostic centre receives approximately 60 to 70 cases monthly, and the authors argue that sampling across 16 facilities reduced the risk of over-representing the practices of a single centre. Only ultrasound, x-ray and computed tomography requests were included, because modalities such as MRI, gamma camera and angiography were unavailable at the facility during the audit period.
The standard against which the forms were judged required 100 percent completion of key fields, based on Royal College of Radiologists guidelines and a published report by Akintomide and colleagues. Each referral was expected to include the patient’s name, age, sex and contact details, the date of the request, clinical history and examination findings, a provisional diagnosis, the requested radiology examination, the referring ward or clinic, and the referring doctor’s name and signature. Forms that did not identify the referring hospital were excluded, as were requests from government-owned facilities and from private hospitals outside the Asaba metropolitan area. Data were analysed descriptively in SPSS version 23, with each field scored as complete or incomplete; no inferential statistics were applied because the study was designed to assess compliance trends rather than test hypotheses.
The first cycle’s findings were stark. No form was completely filled. The highest completion rate for any single form was 92.9 percent and the lowest was 7.1 percent. The most frequently completed entries were the patient’s name, present on 299 forms (93.4 percent), the requested radiological investigation, present on 288 forms (93.1 percent), the referring doctor’s name and signature, on 275 forms (85.9 percent), and the patient’s sex, on 82.5 percent of forms. Examination findings were the least completed field, appearing on only 45 forms, or 14.1 percent. Most forms fell into the lower completion ranges: six forms were less than 10 percent complete, 22 fell in the 21 to 30 percent range, and as many as 85 were only 41 to 50 percent complete. Just three forms achieved more than 90 percent completion. In that first cycle, 251 requests, or 78.4 percent, arrived on conventional printed forms, while 69, or 21.6 percent, were written on plain paper.
Between the two cycles, the audit team implemented a set of deliberately low-cost interventions. The audit report was presented to the managements of the private hospitals involved and at the 2023 Annual General and Scientific Conference of the Association of Radiologists in Nigeria. Recommendations included redesigning request forms to provide adequate spacing for the required fields and distributing leaflets and guides to the clinics explaining how to complete them, delivered through the promotion staff of the diagnostic centre. Hospitals were contacted through the service numbers printed on their own forms, informed of the general findings without any mention of individual practitioners, and encouraged to have their doctors fill forms thoroughly. Follow-up was conducted routinely over WhatsApp, with hospital doctor leads contacted and encouraged to improve compliance.
The re-audit six months later recorded a striking shift. In the second cycle, 291 requests, or 90.9 percent, arrived on conventional radiology forms and only 29, or 9.1 percent, on plain paper. The most thoroughly completed form achieved a perfect 100 percent, and the least completed form reached 60 percent; no form fell below that threshold. The distribution of completion rates moved decisively upward: only 31 forms fell within the 71 to 80 percent range, 95 reached 81 to 90 percent, and 177 forms, more than half of all submissions, were fully completed at 91 to 100 percent. In the re-audit, patients’ names and the imaging modality of choice were included on all forms, and every other component of the form also improved significantly. Overall, six percent of all forms were completely filled, a change from zero in the first cycle.
The authors place their findings in a wider African context in which incomplete request documentation appears to be a persistent problem. They cite reports from Ghana, where clinical history was absent in more than 70 percent of forms; from Sudan, where demographic and clinical details were missing in over 60 percent of requests; and from Zambia, where fewer than 20 percent of request forms contained adequate clinical information. They argue that these patterns confirm incomplete documentation as a widespread challenge across African healthcare systems, one that leads to misinterpretation and diagnostic delay when clinical context is missing, increases administrative burden and the risk of unnecessary tests, and compromises patient safety. Comparable improvement efforts have also been reported elsewhere, including documented compliance gains in Ghana after interventions, improved completion in Sudan following awareness campaigns, and substantial increases in completion rates in Pakistan after the introduction of electronic request systems.
The audit also highlights why private facilities pose particular difficulties for quality improvement. These facilities vary in budget, funding, infrastructure and manpower, and each tends to use its own idiosyncratic request form, which entrenches existing practices and makes it hard for staff to adapt to new systems. Unlike government-owned facilities, private hospitals operate independently without standard regulations, so uniform changes are difficult to adopt across institutions. The authors recommend that private facilities adopt systems of continuous learning similar to those in tertiary institutions, with routine training for doctors on the importance of accurate form completion, open feedback channels between radiologists and referring physicians to foster accountability, regular quality improvement programmes, and joint meetings among administrators and policymakers from different hospitals to advocate for standardised protocols.
The authors are careful to spell out the audit’s limitations. It was conducted only among private clinics in a single urban setting, which restricts generalisability to other regions and to public facilities with different oversight structures. Only the modalities available at the diagnostic centre were assessed, excluding MRI, angiography and nuclear medicine. The audit relied solely on what was documented on the forms, with no opportunity to confirm missing details against patient records or by contacting clinicians, which may have led to underestimation of true compliance. The relatively short interval between cycles may have amplified the immediate effect of sensitisation and feedback, raising questions about whether the improvements will be sustained, and real-world factors such as staff workload and time pressure could have influenced completion in ways the data cannot capture. The authors also acknowledge the possibility of a Hawthorne effect, in which clinicians improved their form completion simply because they knew they were being observed rather than because of lasting behavioural change. They call for larger, multicentre audits, longer follow-up periods, and strategies that address the human and systemic factors influencing compliance, while concluding that continuous training and communication between referring physicians in private clinics and radiologists are crucial to sustaining the gains observed.
Subject of Research: An audit of radiology request form completeness in private clinics in Asaba, Nigeria, before and after quality improvement interventions
Article Title: Assessing compliance: an audit of radiology request forms among private hospitals in Asaba, Delta state
Article References: Udam, N. G., Obaje, P. A., Udam, T. G., Kelechi, K. V., Ike, W. I., Daburak, F. K., & Agabi, J. O. (2026). Assessing compliance: an audit of radiology request forms among private hospitals in Asaba, Delta state. Egyptian Journal of Radiology and Nuclear Medicine, 57(1), Article 230. https://doi.org/10.1186/s43055-026-01896-9
Image Credits: AI Generated
DOI: 10.1186/s43055-026-01896-9
Keywords: radiology request forms, clinical audit, Nigeria, private hospitals, Asaba, Royal College of Radiologists, patient safety, documentation quality, quality improvement, medical imaging, radiology, healthcare compliance
News Source: Ophelia Keating. (October 28, 2026). Audit finds incomplete radiology request forms in Nigerian private clinics improve after targeted feedback. Scienmag.
