Utilization effect of integrating a chest radiography room into a thoracic surgery ward.
OBJECTIVE
Bedside chest radiography (CXR) represents a substantial fraction of the volume of medical imaging for inpatient health care facilities. However, its image quality is limited compared with posterior-anterior/lateral (PA/LAT) acquisitions taken in radiographic rooms. The aim of this study was to evaluate the utilization of bedside CXR and other chest imaging modalities before and after placing a radiography room within a thoracic surgical inpatient ward.


METHODS
All patient admissions (n = 3,852) to the thoracic surgical units between April 1, 2007, and December 31, 2010, were retrospectively identified. All chest imaging tests performed for these patients, including CT scans, MRI, ultrasound, and bedside and PA/LAT radiography, were counted. The primary outcome measure was chest imaging utilization, defined as the number of chest examinations per admission, before and after the establishment of the digital radiography room on January 10, 2010. Statistical analysis was performed using an independent-samples t test to evaluate changes in chest imaging utilization.


RESULTS
A 2.61-fold increase in the number of PA/LAT CXR studies per admission (P < .01) and a 1.96-fold decrease in the number of bedside CXR studies per admission (P < .01) were observed after radiography room implementation. The number of chest CT, MRI, and ultrasound studies per admission did not change significantly.


CONCLUSIONS
Establishing a radiography room physically within thoracic surgery units or in close proximity can significantly shift CXR utilization from bedside to PA/LAT acquisitions, which may enable opportunities for improvement in efficiency, quality, and safety in patient care.
Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA. cmaehara@partners.org
Cleo K
CK
Maehara
Francine
F
Jacobson
Katherine P
KP
Andriole
Ramin
R
Khorasani
D008404:Massachusetts; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D018511:Systems Integration; D013903:Thoracic Surgery / Q000706:statistics & numerical data*; D014600:Utilization Review