[Decrease of unnecessary chest x-rays in Intensive Care Unit: application of a combined cycle of quality improvement]

Area of Science:

• Critical Care Medicine
• Radiology
• Healthcare Quality Improvement

Background:

• Routine portable chest x-rays (CPRs) in Intensive Care Units (ICUs) are often overused.
• Establishing clear indications and interdisciplinary agreement can optimize imaging practices.

Purpose of the Study:

• To demonstrate how interdisciplinary consensus and monitoring reduce unnecessary routine x-ray examinations in the ICU.
• To maintain a low percentage of CPR requests through continuous quality improvement.

Main Methods:

• Implemented an agreed-upon protocol for CPR indications in an 18-bed polyvalent ICU.
• Introduced a consensus system requiring agreement between two intensivists for non-urgent CPR requests.
• Established a monitoring schedule to track compliance and detect deviations.

Main Results:

• The overall non-compliance rate (ONCR) for CPR indications decreased from 16.9% in 1997 to 6.1% after initial protocol implementation.
• Lack of follow-up led to an increase in ONCR to 27.6% by 2003.
• The consensus system reduced non-compliance to 2.5% in 2003, with stable patients being a key area for reduction.

Conclusions:

• Unnecessary CPRs can be effectively reduced by focusing on clinically stable patients and requiring justification for requests.
• Mandatory agreement between intensivists is a key strategy for decreasing routine portable chest x-rays.
• Periodic monitoring is essential for sustaining quality improvements in critical care imaging.