Implementation of a quality improvement initiative to reduce daily chest radiographs in the intensive care unit.
OBJECTIVE
To reduce the number of routine chest radiographs (CXRs) done in a tertiary care intensive care unit (ICU).


METHODS
Using a quality improvement approach, we measured the number of CXRs done per patient-day before (15 June 2010-15 June 2011) and after (15 June 2011-15 June 2012) a multipronged intervention in a 15-bed medical-surgical ICU in a 350-bed tertiary care teaching hospital. We studied a total of 1492 patients who were admitted to this ICU-738 patients during the preintervention period and 754 patients during the postintervention period. Interventions were education for the ICU house staff, developing indications for routine CXRs on the computer order-entry system, and visual posters/signage to remind ICU staff that there were no indications for routine, daily CXRs. The primary outcome was the number of CXRs per patient-day, but we also measured CTs of the chest, mechanical ventilator days, length of ICU stay and ICU and hospital mortality.


RESULTS
There were 0.73 CXRs per patient-day done during the preintervention period and 0.54 CXRs per patient-day done during the postintervention period, a 26% reduction. There were no differences between the periods in age, sex or severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE) II score) of the patients, number of chest CTs, mechanical ventilator days, length of ICU stay and ICU or hospital mortality.


CONCLUSIONS
A quality improvement that includes education, reminders of appropriate indications and computerised decision support can decrease the number of routine CXRs in an ICU.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Eric
E
Sy
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Michael
M
Luong
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Michael
M
Quon
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Young
Y
Kim
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Sadra
S
Sharifi
Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Monica
M
Norena
Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Hubert
H
Wong
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Najib
N
Ayas
Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
Jonathon
J
Leipsic
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Peter
P
Dodek
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D017046:Cost Savings; D003422:Critical Care / Q000191:economics / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*
Critical care; Health services research; Healthcare quality improvement; Hospital medicine