Studies suggest that “on-demand” radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied.Materials and methods:
This was a quasi-experimental, pre-post intervention study. Medical directors of two intervention ICUs requested pCXRs be ordered on an on-demand basis at one time point, without controlling or monitoring behavior or providing follow-up.Results:
A total of 11,994 patient days over 18 months were included. Combined characteristics: Age: 56.7, 66% male, 96% survival, APACHE II 14 (IQR: 11–19), mechanical ventilation (MV) (occurrences)/patient admission: mean 0.7 (SD: 0.6; range: 0–5), duration (hours) of MV: 21.7 (IQR: 9.8–81.4) and ICU LOS (days): 2.8 (IQR: 1.8–5.6). Average pCXR rate/patient/day before was 0.93 (95% CI: 0.89–0.96), and 0.73 (95% CI: 0.69–0.77) after. Controlling for severity, daily pCXR rate decreased by 21.7% (p < 0.001), then increased by about 3%/month (p = 0.044). There was no change in APACHE II, mortality, and occurrences or duration of MV, unplanned re-intubations, ICU LOS.Conclusions:
In critically ill adults, pCXR reduction can be achieved in cardiothoracic and trauma/surgical patients with a pragmatic intervention, without adversely affecting patient care, outside a controlled study.