title: Financial impact of elimination of routine chest radiographs in a pediatric intensive care unit.
abstract: OBJECTIVE
  To determine the change in chest radiograph use if each chest radiograph requires a separate order and clinical indication.
  
  
  METHODS
  Prospective, nonrandomized, controlled design with an intervention.
  
  
  METHODS
  The pediatric intensive care unit (PICU) at Primary Children's Medical Center, Salt Lake City, UT.
  
  
  METHODS
  The study comprised 3,727 PICU patients treated between 1992 and 1996.
  
  
  METHODS
  A change in ordering practice: There will be no standing orders for routine daily morning chest radiographs. Each radiograph requires a written order and a clinical indication.
  
  
  RESULTS
  During a 29-month control phase when routine daily chest radiographs were obtained for all intubated patients, 1.026 chest radiographs per patient day were performed. After the intervention, the ratio dropped to 0.653 chest radiographs per patient day, a decrease of 36.4%. This resulted in a (projected) variable cost savings of $45,476. Data were also collected for quality assurance purposes.
  
  
  CONCLUSIONS
  These results demonstrate the impact of an evaluation and subsequent change in radiology ordering practice in our PICU. The change resulted in decreased variability in ordering practice, fewer chest radiographs per patient, and an accompanying cost savings to our patients and payors.
authors.affiliation: Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Price
authors.forename: M J
authors.initials: MJ
authors.lastname: Grant
authors.forename: K
authors.initials: K
authors.lastname: Welkie
mesh_terms: D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine; D005568:Forms and Records Control; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008499:Medical Records; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics* / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D017749:Total Quality Management; D014589:Utah