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

OBJECTIVE: 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. DESIGN AND SETTING: 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. RESULTS: 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. CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-007-0542-1) contains supplementary material, which is available to authorized users