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Updated: Jul 7, 2026
Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
[Decrease of unnecessary chest x-rays in Intensive Care Unit: application of a combined cycle of quality improvement]
F García-Córdoba1, J M García-Santos, G González Díaz
1Unidad de Cuidados Intensivos. Hospital General Universitario José María Morales Meseguer. Servicio Murciano de Salud. Murcia. España. pagc@ono.com
Purpose:
To demonstrate that interdisciplinary consensus improves the quality of work in the daily Intensive Care Unit (ICU), thus avoiding unnecessary routine x-ray examinations. We propose to monitor the results to maintain this low percentage of requests for x-rays.
Design:
Cycle of improvement in care quality.
Setting:
An 18-bed polyvalent ICU.
Patients:
A random sample of patients admitted in ICU during one month.
Interventions:
Establishment of basic agreed on protocol for routine chest portable x-ray (CPR) indications. After assessing the excessive amount of CPR according to those criteria, all intensivists accepted their application. Five years later, a second assessment of the degree of non-compliance was carried out and a monitoring schedule was established in order to avoid making unnecessary CPR again. Furthermore, a consensus between two intensivists was considered obligatory before a CPR request. Accordingly, all non-urgent CPR forms were signed by two intensivists, following the mentioned clinical criteria. VARIABLE: Unsuitable portable chest x-ray indications.
Results:
In 1997, the overall non-compliance rate (ONCR) was 16.9%. After reducing it to 6.1%, lack of follow-up led to a non-compliance rate of 27.6% in 2003. Stable patients with uncomplicated ischemic heart disease (44.4% in 1997 and 53.8% in 2003) accounted for most of the inadequate ONCR indications. By using the consensus system for requesting routine portable x-rays that required the agreement of two intensivists achieved a reduction of non-compliance to 2.5% in 2003. The monitoring schedule designed has made it possible to follow the time of compliance degree and detect relaxation in the prescriptions.
Conclusions:
Unnecessary CPR can be easily reduced stressing our control in clinically stable patients. The requirement to justify a routine request (agreement between intensivists) makes it possible to decrease the number of CPRs. Periodic monitoring is the definitive tool for a successful improvement cycle.
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