Test-ordering strategy in the intensive care unit

Area of Science:

• Medical Imaging
• Critical Care Medicine
• Health Economics

Background:

• Portable chest x-rays (CXRs) are frequently used in intensive care units (ICUs).
• High utilization of CXRs contributes to significant healthcare costs.
• Assessing the impact of interventions to optimize CXR use is crucial for resource management.

Purpose of the Study:

• To evaluate the effectiveness of an intervention aimed at reducing the utilization of portable chest x-rays (CXRs) in the intensive care unit (ICU).
• To determine the impact of reduced CXR use on healthcare costs and patient safety within the ICU setting.

Main Methods:

• Prospective observational study design.
• Inclusion of 2734 consecutive ICU admissions over a 35-month period.
• Collection of data on patient days, ventilator days, CXR orders, costs, Apache II scores, ICU length of stay, mechanical ventilation duration, and extubation-related events.

Main Results:

• A 22.5% reduction in portable chest x-ray (CXR) utilization was observed.
• Achieved cost savings of $109,968 during the study period.
• No adverse clinical outcomes or increased risks (e.g., inadvertent extubations, reintubations) were associated with reduced CXR use.

Conclusions:

• Intervention to reduce portable chest x-ray (CXR) utilization in ICUs is effective.
• Significant cost savings can be realized without compromising patient safety.
• Optimizing diagnostic imaging practices in critical care settings is feasible and beneficial.