Stricter EHR Imaging Rules Reduce X-rays in ICU

Researchers at the Cleveland Clinic (CC, OH, USA) conducted a study to examine if revising the ordering options for imaging in the ICU resulted in any harms to patients. The EHR was modified so that daily chest x-rays could only be ordered for cardiac and thoracic surgery patients; in general, for all other patients, chest x-rays could be ordered only on a one-time basis. CXR were compared in two time periods: from January 1 to June 11, 2018, before the restrictions were implemented, and from June 12 to December 31, 2018, after implementation.

The results revealed that the EHR restrictions led to a 23.5% decrease in the overall number of portable chest x-rays ordered, and a 36.6% decrease in the average number of overnight chest x-rays. There was no increase in the volume of CXR performed during rounding hours to compensate for those decreases; in fact, volume decreased by 15.8%. In addition, the restrictions helped eliminate sleep interruptions and also minimized radiation. The study was presented at the Society of Critical Care Medicine (SCCM) annual congress, held during February 2019 in San Diego (CA, USA).

“This initiative offered a way to improve patient experience, maximize caregiver efficiencies, minimize radiation exposure, and standardize practices, with no negative impact on patient outcomes,” said lead author and study presenter Anita Reddy, MD. “There was no reduction in staff time related to the decrease in x-rays because of the staffing model used at the Cleveland Clinic, but radiologists were able to dedicate their reclaimed time to reading other types of images.”

Daily CXR are common practice for ICUs, even though they are no longer recommended by the American College of Radiology, the Choosing Wisely campaign, and several other U.S. national societies. Potential negative impacts of daily CXR include disturbed sleep that can lead to delirium, and a daily radiation exposure of about 0.1 mSv.

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