减少重症监护病房的胸部 X 光片利用率。

Reducing chest radiography utilization in the medical intensive care unit.

机构信息

Advanced Heart Failure and Transplant Division of Cardiovascular Medicine, UF Health, Gainesville, Florida.

Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida.

出版信息

J Am Assoc Nurse Pract. 2020 May;32(5):390-399. doi: 10.1097/JXX.0000000000000256.

DOI:10.1097/JXX.0000000000000256

PMID:31373963

Abstract

BACKGROUND AND PURPOSE

Daily chest radiographs (CXRs) have long been a routine part of care. However, evidence as well as changing technology has promoted on-demand CXRs as beneficial to patient care. We found that a substantial number of routine daily CXRs were being ordered, with some of the orders staying active even after extubation.

METHODS

Within a 19-bed adult medical ICU, we prospectively utilized 3 intervention phases from October 1, 2014, to February 28, 2018, to reduce routine CXRs. Nurse Practitioners (NP) initiated this quality improvement (QI) project, aiming to reduce the number of unnecessary of CXRs. Interventions included staff survey, routine CXR order removal, duplicate alerts, visual reminders, and an electronic clinical decision support tool. Monthly education of appropriate CXRs and bedside ultrasound were facilitated by NPs. The outcome measures of interest include: the number of CXRs per patient-day, the number of routine and on-demand CXRs, mortality rate, ICU length of stay, and ventilator days, radiation and cost.

CONCLUSIONS

Total number of CXRs per patient-day decreased by 36.1%. The proportion of routine CXRs decreased from 55.37% to 13.18%; on-demand orders increased, from 44.63% to 86.82%; and calculated radiation-exposure per census decreased, from 0.011 to 0.008 mSv. In addition, charges to patients for CXRs decreased by $7,750/month. ICU mortality and ventilator days per census remained stable.

IMPLICATIONS FOR PRACTICE

By an orchestrated process that included creating awareness and desire to change CXR ordering practices, we were able to decrease routine CXRs and increase on-demand utilization while maintaining counterbalance measures.

摘要

背景与目的

胸部 X 光片（CXR）一直是常规护理的一部分。然而，证据和不断变化的技术促进了按需 CXR，认为其对患者护理有益。我们发现，大量常规每日 CXR 被开出，其中一些订单甚至在拔管后仍保持活动状态。

方法

在一个 19 张成人内科重症监护病房的床位，我们从 2014 年 10 月 1 日至 2018 年 2 月 28 日，前瞻性地利用了 3 个干预阶段来减少常规 CXR。护士从业者（NP）发起了这项质量改进（QI）项目，旨在减少不必要的 CXR 数量。干预措施包括员工调查、常规 CXR 订单移除、重复警报、视觉提醒和电子临床决策支持工具。NP 促进了适当的 CXR 和床边超声的每月教育。感兴趣的结果包括：每位患者每天的 CXR 数量、常规和按需 CXR 的数量、死亡率、重症监护病房的住院时间和呼吸机使用时间、辐射和成本。

结论

每位患者每天的 CXR 总数减少了 36.1%。常规 CXR 的比例从 55.37%下降到 13.18%；按需订单增加，从 44.63%增加到 86.82%；每普查计算的辐射暴露减少，从 0.011 减少到 0.008 mSv。此外，每位患者的 CXR 费用每月减少了 7750 美元。重症监护病房死亡率和每普查呼吸机使用时间保持稳定。