Test-ordering strategy in the intensive care unit.
The objective of this study was to assess the effect of an intervention designed to reduce utilization of portable chest x-rays (CXRs) in the intensive care unit (ICU). In this prospective observational study, patients representing 2734 consecutive admissions over a 35-month period were studied. Data collected from the comprehensive ICU database included patient days, ventilator days, number of admissions to the unit, number of CXRs ordered, costs for CXR, Acute Physiology and Chronic Health Evaluation II (Apache II) scores, ICU length of stay (LOS), length of mechanical ventilation, inadvertent extubations from mechanical ventilation, and reintubation within 48 hours of planned extubation. There was a 22.5% reduction in the rate CXR utilization during the study period, resulting in a $109,968 cost savings, and these savings were not associated with any adverse clinical outcomes.
Critical Care, The Stamford Hospital, Stamford, CT 06902, USA. James_Krinsley@stamhosp.chime.org
James Stephen
JS
Krinsley
D018806:APACHE; D003237:Connecticut; D017046:Cost Savings; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data*; D005568:Forms and Records Control; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006788:Hospitals, Voluntary; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008499:Medical Records; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D018579:Patient Selection; D019095:Point-of-Care Systems / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors