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J Thorac Cardiovasc Surg 2007;134:139-144
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Elimination of daily routine chest radiographs does not change on-demand radiography practice in post–cardiothoracic surgery patients

Onno Metsa, Peter E. Spronk, MD, PhDb,c, Jan Binnekade, PhDa,d, Jaap Stoker, MD, PhDe, Bas A.J.M. de Mol, MD, PhDf, Marcus J. Schultz, MD, PhDa,c,g,*

a Department of Intensive Care Medicine, University of Amsterdam, Amsterdam, the Netherlands
d Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, the Netherlands
e Department of Radiology, University of Amsterdam, Amsterdam, the Netherlands
f Department of Cardiopulmonary Surgery, University of Amsterdam, Amsterdam, the Netherlands
g Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
b Department of Intensive Care Medicine, Gelre Hospital (Location Lukas), Apeldoorn, the Netherlands
c HERMES Critical Care Group, Amsterdam, The Netherlands.

Received for publication November 16, 2006; revisions received January 11, 2007; accepted for publication February 5, 2007.

* Address for reprints: Marcus J. Schultz, MD, PhD, Department of Intensive Care Medicine, Mail stop C3-329, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. (Email: m.j.schultz{at}amc.uva.nl).

Objective: We sought to determine the effect of elimination of daily routine chest radiographs on chest radiographic practice in cardiothoracic surgery patients in the intensive care unit and the post–intensive care unit ward.

Methods: We used a prospective, comparative study design with an intervention in a 28-bed intensive care unit/post–intensive care unit ward (including a 4-bed medium-care unit) in a university hospital. Cardiothoracic surgery patients were admitted to the intensive care unit during a period of 6 months (3 months before intervention and 3 months after intervention). Daily routine chest radiographs in the intensive care unit were eliminated; all chest radiographs required a clinical indication. Routine chest radiographs were not performed in the post–intensive care unit ward, both before and after the intervention.

Results: Before intervention, in the intensive care unit 353 daily routine chest radiographs and 261 on-demand chest radiographs were obtained in 175 patients; after intervention, 275 on-demand chest radiographs were obtained in 163 patients. Before intervention, in the post–intensive care unit ward 413 on-demand chest radiographs were obtained in 167 patients; after intervention, 445 on-demand chest radiographs were obtained in 161 patients. In the intensive care unit the number of chest radiographs per patient day decreased from 1.8 ± 0.6 to 1.1 ± 0.6. In the post–intensive care unit ward the number of chest radiographs per patient per day was 0.4 ± 0.2, both before and after the intervention. Slightly more unexpected abnormalities were found in the on-demand chest radiographs after the intervention. No negative influence on chest radiography timing, length of stay in the intensive care unit and hospital, and readmission rate was seen.

Conclusions: Elimination of daily routine chest radiographs led to a decrease of the total number of chest radiographs obtained per patient per day in the intensive care unit and did not change chest radiography practice in the post–intensive care unit ward.

Abbreviations and Acronyms CI = confidence interval; ICU = intensive care unit; LOS = length of stay




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