A Quality Improvement Initiative to Reduce Unnecessary Screening Chest Radiographs in a Pediatric Intensive Care Unit

Background: The Critical Care Societies Collaborative included not ordering diagnostic tests at regular intervals as one of their Choosing Wisely initiatives. A reduction in unnecessary chest radiographs can help reduce exposure to radiation and eliminate healthcare waste. We aimed to reduce daily screening chest radiographs in a pediatric intensive care unit (PICU) by 20% from baseline by April 2021.

Methods: All intubated patients in the PICU were included in this quality improvement project. Patients with tracheostomies were excluded. We developed criteria delineating which patients were most likely to benefit from a daily screening chest radiograph and these criteria were discussed for each patient on rounds. Patients on ECMO, on the oscillator, or on high support on conventional mechanical ventilation were included as needing a daily screening chest radiograph. We tracked the percentage of intubated patients receiving a screening chest radiograph as an outcome measure. Unplanned extubations and the number of non-screening chest radiographs per intubated patient were followed as balancing measures.

Results: The percentage of intubated patients receiving a daily screening chest radiograph was reduced from 79% to 31%. There was no increase in frequency of unplanned extubations or number of non-screening chest radiographs. With an estimated patient charge of roughly $270 and hospital cost of $54 per chest radiograph, this project led to an estimated $300,000 in patient charge savings and $60,000 in hospital cost savings.

Conclusions: Adopting criteria to delineate which patients are most likely to benefit from screening chest radiographs can lead to a reduction in the percentage of intubated patients receiving screening chest radiographs without appearing to increase harm.