Shelby Resnick1, Kenji Inaba2, Efstathios Karamanos3, Dimitra Skiada4, James A Dollahite5, Obi Okoye6, Peep Talving7, Demetrios Demetriades8. 1. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: shelby.resnick@uphs.upenn.edu. 2. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: kenji.inaba@med.usc.edu. 3. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: ef.karamanos@gmail.com. 4. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: dimitra.skiada@gmail.com. 5. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: dollahit@med.usc.edu. 6. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: obi.okoye@hotmail.com. 7. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: peep.talving@usc.edu. 8. University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: demetria@usc.edu.
Abstract
INTRODUCTION: A daily Chest X-ray (CXR) is obtained in many surgical intensive care units (SICU). This study implemented a selective CXR protocol in a high volume, academic SICU and evaluated its impact on clinical outcomes. METHODS: All SICU patients admitted in 2/2010 were compared with patients admitted in 2/2012. Between the time periods, a protocol eliminating the routine daily CXRs was instituted. RESULTS: In 02/2010 and 02/2012, 107 and 90 patients were admitted to the SICU, respectively, for a total of 1384 patient days. CXRs decreased from 365 (57.1% of patient-days) in 2010 to 299 (40.9% of patient days; p < 0.001) in 2012. A greater proportion of Physician Directed CXRs (PDCXRs) had new findings (80.8%) compared to Automatic Daily CXRs (ADCXRs) (23.5%, p < 0.001). There was no difference in overall or SICU length of stay, ventilator-free days, morbidity or mortality. CONCLUSION: Eliminating ADCXRs decreased the number of CXRs performed, without affecting LOS, mechanical ventilation, morbidity or mortality. Physician-directed ordering of CXRs increased the diagnostic value of the CXR and decreased the number of clinically irrelevant CXRs performed.
INTRODUCTION: A daily Chest X-ray (CXR) is obtained in many surgical intensive care units (SICU). This study implemented a selective CXR protocol in a high volume, academic SICU and evaluated its impact on clinical outcomes. METHODS: All SICU patients admitted in 2/2010 were compared with patients admitted in 2/2012. Between the time periods, a protocol eliminating the routine daily CXRs was instituted. RESULTS: In 02/2010 and 02/2012, 107 and 90 patients were admitted to the SICU, respectively, for a total of 1384 patient days. CXRs decreased from 365 (57.1% of patient-days) in 2010 to 299 (40.9% of patient days; p < 0.001) in 2012. A greater proportion of Physician Directed CXRs (PDCXRs) had new findings (80.8%) compared to Automatic Daily CXRs (ADCXRs) (23.5%, p < 0.001). There was no difference in overall or SICU length of stay, ventilator-free days, morbidity or mortality. CONCLUSION: Eliminating ADCXRs decreased the number of CXRs performed, without affecting LOS, mechanical ventilation, morbidity or mortality. Physician-directed ordering of CXRs increased the diagnostic value of the CXR and decreased the number of clinically irrelevant CXRs performed.
Authors: Fabiana Madotto; Tài Pham; Giacomo Bellani; Lieuwe D Bos; Fabienne D Simonis; Eddy Fan; Antonio Artigas; Laurent Brochard; Marcus J Schultz; John G Laffey Journal: Intensive Care Med Date: 2018-04-09 Impact factor: 17.440
Authors: Joseph E Tonna; Kensaku Kawamoto; Angela P Presson; Chong Zhang; Mary C Mone; Robert E Glasgow; Richard G Barton; John R Hoidal; Yoshimi Anzai Journal: J Crit Care Date: 2017-10-05 Impact factor: 3.425