Background: The diagnostic yield and therapeutic consequences of daily routine chest x-rays are very low. Several studies show discontinuation of daily routine chest x-rays does not affect ICU length of stay, readmission rate, or hospital mortality.We hereby present results of an educational intervention at a tertiary care university medical center to avoid daily routine chest X rays on intubated adults patients between 2 -5 am and study the impact on health care costs.
Methods: Before January 12, 2015, routine chest x-rays with morning labs were ordered to check the malpositioning of ETT or other complications or missed diagnosis. Physician providers, nursing and other supporting staff were educated in January 2015 to order morning chest x-rays only if required clinically as patients were closely monitored for ETT placement / verification every 4 hours by nurses and every shift by respiratory therapists in ICU settings and any deterioration in patient clinical status could be noted promptly and CXR could then be ordered instantly.
Results: Before intervention in years 2012, 2013, 2014 total 1230, 1794, 1534 chest x-rays respectively were ordered. As the cost for a single chest X ray was 272 $, the total cost for chest X rays were $ 334,646.10, $ 488,093.58 and $ 417,355.38 respectively each year. Thus the average number of Chest X ray in a year was 1519 with a average expenditure of 413,364$.
After educating attendings, nursing and other supporting staff in year 2015 total 1020 routine chest x-rays were ordered and total cost was $ 277,511.40. In year 2016 total 661 routine chest x-rays were ordered and total cost was $ 179,838.27. The average chest X rays these 2 years were thus reduced to 840 with an average cost of 228,674. Thus there was a 44.6% reduction in the cost.
Conclusions: Health care costs was significantly reduced by 44.6% after educating physicians, nursing and other supporting staff to order morning routine chest x-rays only if required clinically as daily routine chest x-rays cause significant financial burden and radiation exposure of patient and staff and also does not prevent complications as demonstrated in prior studies as well.