Moving towards radiation-free tertiary care NICU: a quality improvement initiative

Neonates admitted to intensive care are exposed to frequent radiation due to various reasons. Radiation hazard is an overlooked entity among neonates. Hence, this quality improvement (QI) project was conducted to address the issue. We aimed to reduce the average number of X-rays per neonate in our tertiary neonatal intensive care unit (NICU) from a baseline mean of 1.98 to ≤1.5 within 6 months (March to August 2024) through implementation of the as low as reasonably achievable principle and increased use of point-of-care ultrasound as an alternative to radiography. A dedicated QI team comprising neonatology consultants, residents, nursing staff, and radiography technicians was constituted. In the baseline phase, data on the total number of X-rays performed per patient were analysed over 6 months (August 2023 to January 2024). Contributing factors to increased radiation exposure were identified using a fishbone analysis. Subsequently, a series of stepwise plan-do-study-act cycles was implemented to reduce radiation exposure among neonates. During the baseline period, a total of 204 X-rays were performed on 103 neonates admitted to our NICU, with a mean (±SD) of 1.98 ± 2.16 X-rays per patient. Following the intervention phase (March 2024 through August 2024), a total of 179 X-rays were recorded among 125 neonates, with a reduced mean (±SD) of 1.43 ± 2.72 X-rays per patient. The effective implementation of targeted QI strategies was associated with a reduction in radiation exposure among neonates admitted to the NICU.