Decreasing radiographs in neonates through targeted quality improvement interventions

Area of Science:

• Neonatal intensive care
• Medical imaging
• Quality improvement

Background:

• Radiographs are frequently used in neonatal intensive care units (NICUs) for monitoring the placement of peripherally inserted central catheters (PICCs) and endotracheal tubes (ETTs).
• Excessive radiograph use can lead to increased radiation exposure for vulnerable neonates.

Purpose of the Study:

• To decrease radiograph utilization for monitoring PICC and ETT placement in neonates within the NICU by 20%.
• To optimize imaging protocols and reduce unnecessary radiation exposure in a neonatal intensive care setting.

Main Methods:

• Implementation of a quality improvement (QI) project utilizing three Plan-Do-Study-Act (PDSA) cycles.
• Development and implementation of a standardized radiograph protocol including patient positioning, views, and frequency.
• Standardization of endotracheal tube (ETT) depth using Neonatal Resuscitation Program (NRP) guidelines and institution-specific criteria.

Main Results:

• Significant reduction in radiograph use per PICC day from 0.86 to 0.46 (P=0.004).
• Significant reduction in radiograph use per ETT day from 1.45 to 1.07 (P=0.002).
• Achieved a greater than 20% decrease in overall radiograph use for monitoring PICC and ETT placement.

Conclusions:

• A multidisciplinary QI project effectively reduced radiograph use for PICC and ETT monitoring in the NICU.
• The implemented strategies led to a substantial decrease in imaging frequency, contributing to reduced radiation exposure for neonates.
• The project demonstrates the successful application of QI methodologies to optimize clinical practices in the NICU.