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Journal of Intensive Care Medicine
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Test-Ordering Strategy in the Intensive Care Unit

James Stephen Krinsley, MD, FCCP

Critical Care, The Stamford Hospital, 190 West Broad Street, Stamford, CT 06902 James_Krinsley{at}stamhosp.chime.org

The objective of this study was to assess the effect of an intervention designed to reduce utilization of portable chest x-rays (CXRs) in the intensive care unit (ICU). In this prospective observational study, patients representing 2734 consecutive admissions over a 35-month period were studied. Data collected from the comprehensive ICU database included patient days, ventilator days, number of admissions to the unit, number of CXRs ordered, costs for CXR, Acute Physiology and Chronic Health Evaluation II (Apache II) scores, ICU length of stay (LOS), length of mechanical ventilation, inadvertent extubations from mechanical ventilation, and reintubation within 48 hours of planned extubation. There was a 22.5% reduction in the rate CXR utilization during the study period, resulting in a $109,968 cost savings, and these savings were not associated with any adverse clinical outcomes.

Key Words: intensive care unit • chest x-ray • mechanical ventilation • length of stay • Apache II score • charges

Journal of Intensive Care Medicine, Vol. 18, No. 6, 330-339 (2003)
DOI: 10.1177/0885066603256344
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