PURPOSE: The use of routine daily chest radiographs (CXRs) for mechanically ventilated adult patients is controversial. Recent studies suggest that an on-demand strategy can be adopted where CXRs are obtained on the basis of changes in a patient’s condition. We evaluated the use of a focused educational activity on the use of routine CXRs in mechanically ventilated patients given to physicians providing care to ICU patients.
METHODS: We conducted a retrospective chart review of patients 18 years and above who were mechanically ventilated in the ICU for more than two days in the three month period before the educational activity was given (9/1/09 - 11/30/09), the Pre-intervention group, and the three month period after the educational activity was given (1/1/10 - 3/31/10), the Post-intervention group. The intervention included discussion of current clinical practices and evidence against the use of routine CXR’s which was presented at a divisional meeting where all the ICU faculty and fellows were present on December 15, 2009. In view of evidence, a consensus was reached to abandon routine CXR’s. We collected demographic data including gender, race, diagnosis, length of stay, outcome (transfer, discharge, death and continued stay in the ICU) as well as total number of CXRs and number of days of mechanical ventilation during pre- and post- intervention period. Data was presented as raw numbers and percent, and a t test was conducted to compare the outcomes between the two groups.
RESULTS: There were 44 patients in the Pre-intervention group and 49 patients in the Post-intervention group. The groups were similar in their baseline characteristics. The total number of CXR in the Pre-intervention group was 494 compared to 215 in the Post-intervention group (p<0.0001). The total number of days of mechanical ventilation was 520 Vs 452 (p=0.141). The number of CXR per mechanical ventilation days (CXR/MV days) was 0.95 Vs 0.48 (p<0.0001). There was no difference in length of stay or mortality between the two groups.
CONCLUSIONS: A focused educational activity targeted to primary stake holders can influence clinical practices.
CLINICAL IMPLICATIONS: Early adoption of evidence based medicine into daily clinical practice is feasible through focused education activities of ICU physicians.
DISCLOSURE: The following authors have nothing to disclose: Kiran Ubhayakar, Gerardo Garza, Victor Cardenas, Gulshan Sharma
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