Researchers from Mount Sinai Beth Israel, in New York, New York, created a quality improvement initiative in 2012, recommending a restrictive approach to ordering chest x-rays (CXRs) compared with ordering them routinely. They hypothesized that this restrictive approach would significantly reduce patients' exposure to radiation and reduce ICU operating costs without adversely affecting patient outcomes.
A restrictive approach to ordering CXRs was implemented at a teaching hospital in January 2012, and a retrospective review was later conducted of all ICU patients from 2011-2014 to examine the effectiveness. Results found that a restrictive approach led to large decreases in total CXRs ordered, correcting for both total number of patients and ventilator days. No negative impact on the total number of patient ventilator days, length of stay, and other outcomes was found.
"A restrictive approach to ordering chest x-rays in the ICU appears to be a safe practice," said Dr. Jason Filopei, Mount Sinai Beth Israel physician and lead researcher. "We believe it will lead to a significant saving of hospital resources."