Joseph E Tonna1, Kensaku Kawamoto2, Angela P Presson3, Chong Zhang4, Mary C Mone5, Robert E Glasgow6, Richard G Barton7, John R Hoidal8, Yoshimi Anzai9. 1. Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, United States; Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, UT, United States. Electronic address: joseph.tonna@hsc.utah.edu. 2. Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States. Electronic address: kensaku.kawamoto@utah.edu. 3. Division of Epidemiology, University of Utah, Salt Lake City, UT, United States. Electronic address: angela.presson@hsc.utah.edu. 4. Division of Epidemiology, University of Utah, Salt Lake City, UT, United States. Electronic address: Chong.Zhang@hsc.utah.edu. 5. Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, United States. Electronic address: Mary.Mone@hsc.utah.edu. 6. Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, United States. Electronic address: Robert.Glasgow@hsc.utah.edu. 7. Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, United States. Electronic address: Richard.Barton@hsc.utah.edu. 8. Department of Medicine, University of Utah, Salt Lake City, UT, United States. Electronic address: John.Hoidal@hsc.utah.edu. 9. Department of Radiology, University of Utah, Salt Lake City, UT, United States. Electronic address: Yoshimi.Anzai@hsc.utah.edu.
Abstract
PURPOSE: Studies suggest that "on-demand" radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied. MATERIALS AND METHODS: This was a quasi-experimental, pre-post intervention study. Medical directors of two intervention ICUs requested pCXRs be ordered on an on-demand basis at one time point, without controlling or monitoring behavior or providing follow-up. RESULTS: A total of 11,994 patient days over 18months were included. Combined characteristics: Age: 56.7, 66% male, 96% survival, APACHE II 14 (IQR: 11-19), mechanical ventilation (MV) (occurrences)/patient admission: mean 0.7 (SD: 0.6; range: 0-5), duration (hours) of MV: 21.7 (IQR: 9.8-81.4) and ICU LOS (days): 2.8 (IQR: 1.8-5.6). Average pCXR rate/patient/day before was 0.93 (95% CI: 0.89-0.96), and 0.73 (95% CI: 0.69-0.77) after. Controlling for severity, daily pCXR rate decreased by 21.7% (p<0.001), then increased by about 3%/month (p=0.044). There was no change in APACHE II, mortality, and occurrences or duration of MV, unplanned re-intubations, ICU LOS. CONCLUSIONS: In critically ill adults, pCXR reduction can be achieved in cardiothoracic and trauma/surgical patients with a pragmatic intervention, without adversely affecting patient care, outside a controlled study.
PURPOSE: Studies suggest that "on-demand" radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied. MATERIALS AND METHODS: This was a quasi-experimental, pre-post intervention study. Medical directors of two intervention ICUs requested pCXRs be ordered on an on-demand basis at one time point, without controlling or monitoring behavior or providing follow-up. RESULTS: A total of 11,994 patient days over 18months were included. Combined characteristics: Age: 56.7, 66% male, 96% survival, APACHE II 14 (IQR: 11-19), mechanical ventilation (MV) (occurrences)/patient admission: mean 0.7 (SD: 0.6; range: 0-5), duration (hours) of MV: 21.7 (IQR: 9.8-81.4) and ICU LOS (days): 2.8 (IQR: 1.8-5.6). Average pCXR rate/patient/day before was 0.93 (95% CI: 0.89-0.96), and 0.73 (95% CI: 0.69-0.77) after. Controlling for severity, daily pCXR rate decreased by 21.7% (p<0.001), then increased by about 3%/month (p=0.044). There was no change in APACHE II, mortality, and occurrences or duration of MV, unplanned re-intubations, ICU LOS. CONCLUSIONS: In critically ill adults, pCXR reduction can be achieved in cardiothoracic and trauma/surgical patients with a pragmatic intervention, without adversely affecting patient care, outside a controlled study.
Authors: R J Graham; M A Meziane; T W Rice; T Agasthian; N Christie; K Gaebelein; N A Obuchowski Journal: J Thorac Cardiovasc Surg Date: 1998-01 Impact factor: 5.209
Authors: Marleen E Graat; Anke Kröner; Peter E Spronk; Johanna C Korevaar; Jaap Stoker; Margreeth B Vroom; Marcus J Schultz Journal: Intensive Care Med Date: 2007-02-28 Impact factor: 17.440