title: [Decrease of unnecessary chest x-rays in Intensive Care Unit: application of a combined cycle of quality improvement].
abstract: OBJECTIVE
  To demonstrate that interdisciplinary consensus improves the quality of work in the daily Intensive Care Unit (ICU), thus avoiding unnecessary routine x-ray examinations. We propose to monitor the results to maintain this low percentage of requests for x-rays.
  
  
  METHODS
  Cycle of improvement in care quality.
  
  
  METHODS
  An 18-bed polyvalent ICU.
  
  
  METHODS
  A random sample of patients admitted in ICU during one month.
  
  
  METHODS
  Establishment of basic agreed on protocol for routine chest portable x-ray (CPR) indications. After assessing the excessive amount of CPR according to those criteria, all intensivists accepted their application. Five years later, a second assessment of the degree of non-compliance was carried out and a monitoring schedule was established in order to avoid making unnecessary CPR again. Furthermore, a consensus between two intensivists was considered obligatory before a CPR request. Accordingly, all non-urgent CPR forms were signed by two intensivists, following the mentioned clinical criteria. VARIABLE: Unsuitable portable chest x-ray indications.
  
  
  RESULTS
  In 1997, the overall non-compliance rate (ONCR) was 16.9%. After reducing it to 6.1%, lack of follow-up led to a non-compliance rate of 27.6% in 2003. Stable patients with uncomplicated ischemic heart disease (44.4% in 1997 and 53.8% in 2003) accounted for most of the inadequate ONCR indications. By using the consensus system for requesting routine portable x-rays that required the agreement of two intensivists achieved a reduction of non-compliance to 2.5% in 2003. The monitoring schedule designed has made it possible to follow the time of compliance degree and detect relaxation in the prescriptions.
  
  
  CONCLUSIONS
  Unnecessary CPR can be easily reduced stressing our control in clinically stable patients. The requirement to justify a routine request (agreement between intensivists) makes it possible to decrease the number of CPRs. Periodic monitoring is the definitive tool for a successful improvement cycle.
authors.affiliation: Unidad de Cuidados Intensivos. Hospital General Universitario José María Morales Meseguer. Servicio Murciano de Salud. Murcia. España. pagc@ono.com
authors.forename: F
authors.initials: F
authors.lastname: García-Córdoba
authors.forename: J M
authors.initials: JM
authors.lastname: García-Santos
authors.forename: G
authors.initials: G
authors.lastname: González Díaz
authors.forename: A
authors.initials: A
authors.lastname: García-Gerónimo
authors.forename: F
authors.initials: F
authors.lastname: Muñoz Zambudio
authors.forename: F
authors.initials: F
authors.lastname: Peñalver Hernández
authors.forename: L
authors.initials: L
authors.lastname: Del Baño Aledo
mesh_terms: D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D011786:Quality Control; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*