Wayne State University, Detroit, MI
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Critical Care - ICU Management
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
PURPOSE: Misuse of “Stat” radiology orders is a common problem in many health systems. 1 Literature review has shown that a high number of inappropriate stat imaging is not only misuse of resources but it delays the reporting time for images which in turn defers critical decision making2. In our hospital system, stat imaging was not being read for several hours because of high number of inappropriate stat imaging orders. The objective of this quality improvement project was to decrease the number of inappropriate stat imaging, which in turn is expected to decrease the workload on the radiology department
METHODS: This is a prospective study done in a PDSA model aiming at decreasing unnecessary stat radiology orders so that resources are appropriately utilized for patients in “real” need for immediate imaging and interpretation of images. In our first PDSA cycle we focused on the MICU resident team and educated them on the importance and proper use of stat imaging. This was done through a brief presentation on appropriate order priority. A power point presentation consisted of data on inappropriate orders during preceding months and suggestions on how unnecessary stat imaging can be limited. A Poster in the Critical care office with suggestions of appropriate priorities was also placed. The presentation was given to every four weeks to each incoming medicine resident team. For time analysis we took an average of 10 stat and routine imaging orders selected randomly for pre and post intervention periods
RESULTS: 12-week pre intervention data was compared to 12-week post intervention data in the first PDSA cycle. An average of 80 stat radiology tests a week are ordered in critical care units (5R and 5P) by medicine, surgery and neurology residents. 82.6% of all stat orders in the MICU are one view portable chest radio-graphs. Preliminary results show a decrease from 73.8% stat orders to 44.2% after intervention, which is a 29.6% decrease. Analysis also shows that the order to image capture time is under 30 minutes (mean 24.5 minutes) for stat one view portable imaging and under 45 minutes (mean 44.2 minutes) for routine one view portable imaging. Average image capture to preliminary report time for stat one view portable imaging during the pre intervention period was found to be 60.5 minutes compared to 65 minutes in the post intervention period. Portable one view routine imaging took an average of 229 minutes (3.8 hrs) to get reported in the Pre intervention period and 218 minutes (3.6 hrs) in the Post intervention period.
CONCLUSIONS: Our study has objectively shown a significant decrease in the number of stat one-view portable radiology orders through a simple educational intervention. We also conclude that a system wide educational intervention is required to curb the inappropriate stat imaging ordered in the hospital. This may prove not only to be cost effective but may also decrease the reporting time.
CLINICAL IMPLICATIONS: see conclusion
DISCLOSURE: The following authors have nothing to disclose: Samran Haider, Sai Konduri, Rohit Gupta, Chaitanya Mandapakala, Ghulam Saydain
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