Cutting $5M in potential costs by restricting chest x-ray use in the ICU

Overuse of portable chest x-rays is a common and overlooked problem among intensive care units. But experts at one New York institution may have discovered a remedy for this issue that could pay off big in the years to come.

Scientists with New York Health and Hospitals formed a multi-disciplinary team that was able to tackle excessive imaging at one of the hospital system’s locations. They were able to drop use of portable chest radiography in the adult ICU by 37% without any corresponding uptick in complications or extubations.

In just one month the intervention saved $4,000 and, if extrapolated across the entire hospital giant, could potentially save NYHH $5 million over the next decade, experts detailed Thursday in JACR.

“Ultimately, the impressive outcomes of this performance improvement initiative are related directly to the significant success the radiology department had assembling a multidisciplinary team of key stakeholders around a common goal and establishing ‘buy-in’ from the clinicians,” wrote lead author Jinel Scott MD, MBA, and colleagues. “The team understood that to sustain any improvements, a more comprehensive, systematic approach will be needed,” they added later.

Representatives from radiology, surgery, internal medicine and nursing all played a part in the initiative. After forming their team, Scott and colleagues got to work by mapping out the process of performing chest x-rays, with rad residents and techs conducting “time trials” to determine the length and cost of the imaging process.

Scott and colleagues began to address this issue with a blend of “weak” and “stronger” interventions. Those included modifying resident education in the former category, along with eliminating standing orders and changing workflows in the latter. The team emphasized that providers should only order CXR in specific situations, such as the initial admission or following a central-line placement.

With success over the course of a six-month period at Kings County Hospital, they’re now devising how to spread this best practice to the other 10 hospitals in NYHH. Scott—the director of emergency radiology, quality and patient safety at KCH—encourages other radiologists to similarly think bigger in their work.

“The value radiology departments bring to institutions should extend beyond image interpretation. Both radiology leadership and front-line staff members should take a central role in implementing already established, evidence-based practices in imaging,” she and colleagues concluded.

You can read the full study in the Journal of the American College of Radiology here.