In this study, they asked the intensivists to judge the clinical value (therapeutic efficacy) of routine and on-demand chest radiographs and to judge the value of an established radiologic evaluation with a radiologist and asked them to state some indications for routine chest radiographs. The therapeutic efficacy of routine chest radiographs was between 10% and 20% compared with that between 10% and 60% for on-demand chest radiographs. In a prospective study by Mets et al [7] and a meta-analysis by Ganapathy et al [8], elimination of daily routine chest radiographs and a restrictive approach with chest radiographs performed to investigate clinical changes among critically ill patients led to a decrease in the total number of chest radiographs obtained per patient per day in the ICU, and, without negative influence on length of stay in the ICU and hospital, a decrease in the readmission rate. A study from a university hospital in British Columbia, Canada, evaluated their quality improvement initiative to reduce daily chest radiographs in the ICU. The authors observed that education, reminders of appropriate indications, and computerized decision support were effective in decreasing the number of routine chest radiographs in an ICU by 26%. There were no differences between the periods in age, sex, or severity of illness (Acute Physiology and Chronic Health Evaluation [APACHE] II score) of the patients, number of chest CTs, mechanical ventilator days, length of ICU stay, and ICU or hospital mortality [9]. Another study by Tolsma et al [10] with a total of 1,102 consecutive cardiac surgery patients showed that the diagnostic efficacy of chest radiographs for major abnormalities was higher for the postoperative on-demand chest radiographs (n = 301; 27%) than for the routine chest radiographs taken the morning after surgery (n = 801; 73%) Intensive Care Unit Patients (6.6% versus 2.7%, P = . 004).
Intensive Care Unit Patients. In this study, they asked the intensivists to judge the clinical value (therapeutic efficacy) of routine and on-demand chest radiographs and to judge the value of an established radiologic evaluation with a radiologist and asked them to state some indications for routine chest radiographs. The therapeutic efficacy of routine chest radiographs was between 10% and 20% compared with that between 10% and 60% for on-demand chest radiographs. In a prospective study by Mets et al [7] and a meta-analysis by Ganapathy et al [8], elimination of daily routine chest radiographs and a restrictive approach with chest radiographs performed to investigate clinical changes among critically ill patients led to a decrease in the total number of chest radiographs obtained per patient per day in the ICU, and, without negative influence on length of stay in the ICU and hospital, a decrease in the readmission rate. A study from a university hospital in British Columbia, Canada, evaluated their quality improvement initiative to reduce daily chest radiographs in the ICU. The authors observed that education, reminders of appropriate indications, and computerized decision support were effective in decreasing the number of routine chest radiographs in an ICU by 26%. There were no differences between the periods in age, sex, or severity of illness (Acute Physiology and Chronic Health Evaluation [APACHE] II score) of the patients, number of chest CTs, mechanical ventilator days, length of ICU stay, and ICU or hospital mortality [9]. Another study by Tolsma et al [10] with a total of 1,102 consecutive cardiac surgery patients showed that the diagnostic efficacy of chest radiographs for major abnormalities was higher for the postoperative on-demand chest radiographs (n = 301; 27%) than for the routine chest radiographs taken the morning after surgery (n = 801; 73%) Intensive Care Unit Patients (6.6% versus 2.7%, P = . 004).