Malin, Stefan W.Maue, Danielle K.Cater, Daniel T.Ealy, Aimee R.McCallister, Anne E.Valentine, Kevin M.Abu-Sultaneh, Samer M.2024-11-112024-11-112023Malin SW, Maue DK, Cater DT, et al. A Quality Improvement Initiative to Reduce Unnecessary Screening Chest Radiographs in a Pediatric ICU. Respir Care. 2023;68(10):1377-1384. doi:10.4187/respcare.10689https://hdl.handle.net/1805/44484Background: 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 (CXRs) can help reduce exposure to radiation and eliminate health care waste. We aimed to reduce daily screening CXRs in a pediatric ICU (PICU) by 20% from baseline within 4 months of implementation of CXR criteria. 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 CXR, and these criteria were discussed for each patient on rounds. Patients on extracorporeal membrane oxygenation, on high-frequency oscillatory ventilation, or on high support on conventional mechanical ventilation were included as needing a daily screening CXR. We tracked the percentage of intubated subjects receiving a screening CXR as an outcome measure. Unplanned extubations and the number of non-screening CXRs per intubated subject were followed as balancing measures. Results: The percentage of intubated subjects receiving a daily screening CXR was reduced from 79% to 31%. There was no increase in frequency of unplanned extubations or number of non-screening CXRs. With an estimated subject charge of roughly $270 and hospital cost of $54 per CXR, 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 CXRs can lead to a reduction in the percentage of intubated patients receiving screening CXRs without appearing to increase harm.en-USPublisher PolicyChest radiographsWasteUnplanned extubationsQualityRadiologyIntubatedPediatricArticle