Elimination of daily routine chest radiographs in a mixed medical–surgical intensive care unit

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Abstract
To determine the impact of elimination of daily routine chest radiographs (CXRs) in a mixed medical–surgical intensive care unit (ICU) on utility of on demand CXRs, length of stay (LOS) in ICU, readmission rate, and mortality rate. Prospective, nonrandomized, controlled study in a 28-bed ICU. Analysis included data of all admitted ICU patients during 5 months before and after elimination of daily routine CXRs. Before elimination, 2457 daily routine CXRs and 1437 on demand CXRs were obtained from 754 patients. After elimination, 1267 CXRs were obtained from 622 patients. The ratio of CXRs/patient day decreased from 1.1 ± 0.3 to 0.6 ± 0.4 (p < 0.05). Elimination did not result in a change in utility and timing of on demand CXRs. The absolute diagnostic and therapeutic value of on demand CXRs increased with elimination of daily routine CXRs: before intervention, 147 unexpected predefined abnormalities were found (10.2% of all on demand CXRs in 15.9% of all patients), of which 57 (3.9%) in 6.4% of all patients led to a change in therapy. After intervention, 156 unexpected predefined abnormalities were found (11.6%; p < 0.05), of which 61 (4.8%) in 9.5% of all patients (p < 0.05) led to a change in therapy. The LOS in ICU, readmission rate and ICU, and hospital mortality rate were not influenced by the change in strategy. Elimination of daily routine CXRs reduced the number of CXRs in a mixed medical–surgical ICU, while not affecting readmission rate and ICU and hospital mortality rates.