Elimination of daily routine chest radiographs in a mixed medical-surgical intensive care unit

Marleen E. Graat, Anke Kroner, Peter E. Spronk, Johanna C. Korevaar, Jaap Stoker, Margreeth B. Vroom, Marcus J. Schultz

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Abstract

OBJECTIVE: To determine the impact of elimination of daily routine chest radiographs (CXRs) in a mixed medical-surgical intensive care unit (ICU) on utility of on demand CXRs, length of stay (LOS) in ICU, readmission rate, and mortality rate. DESIGN AND SETTING: Prospective, nonrandomized, controlled study in a 28-bed ICU. Analysis included data of all admitted ICU patients during 5 months before and after elimination of daily routine CXRs. RESULTS: Before elimination, 2457 daily routine CXRs and 1437 on demand CXRs were obtained from 754 patients. After elimination, 1267 CXRs were obtained from 622 patients. The ratio of CXRs/patient day decreased from 1.1+/-0.3 to 0.6+/-0.4 (p <0.05). Elimination did not result in a change in utility and timing of on demand CXRs. The absolute diagnostic and therapeutic value of on demand CXRs increased with elimination of daily routine CXRs: before intervention, 147 unexpected predefined abnormalities were found (10.2% of all on demand CXRs in 15.9% of all patients), of which 57 (3.9%) in 6.4% of all patients led to a change in therapy. After intervention, 156 unexpected predefined abnormalities were found (11.6%; p <0.05), of which 61 (4.8%) in 9.5% of all patients (p <0.05) led to a change in therapy. The LOS in ICU, readmission rate and ICU, and hospital mortality rate were not influenced by the change in strategy. CONCLUSIONS: Elimination of daily routine CXRs reduced the number of CXRs in a mixed medical-surgical ICU, while not affecting readmission rate and ICU and hospital mortality rates
Original languageEnglish
Pages (from-to)639-644
JournalIntensive Care Medicine
Volume33
Issue number4
DOIs
Publication statusPublished - 2007

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