Improving timeliness of STAT portable radiographs in pediatric critical care

Timely and accurate portable radiographs are essential in the pediatric intensive care unit (PICU) for managing critically ill patients. However, an overuse of STAT orders for non-urgent exams leads to inefficiencies, delays, and strains on resources. This project aimed to increase the percentage of STAT radiographs performed within 30 min and improve the appropriateness of STAT orders in a high-volume PICU.

A quality improvement initiative was conducted in a quaternary care pediatric hospitals using the ACR ImPower methodology. A multidisciplinary team restructured the technologist staffing model, introduced standardized criteria for STAT/ASAP orders, and developed a communication tip sheet for nursing staff ordering portable radiographs. Data were tracked using statistical process control charts, and results were compared pre- and post-intervention.

From January to September 2024, STAT radiographs completed within 30 min increased from 55 to 71%, and mean turnaround time decreased from 71 to 38 min. Compliance with communication standards improved, while the appropriateness of STAT orders increased modestly from 42 to 44%.

This QI project significantly improved the timeliness and workflow efficiency for STAT radiographs in the PICU, though further efforts are needed to fully standardize STAT order usage and communication practices.